Abstract 16235: Older Patients Presenting With Cardiogenic Shock Have Worse Outcomes: Insights From a Quaternary Referral Center Registry

Abstract

Background Cardiogenic shock (CS) is a life-threatening clinical syndrome of reduced cardiac output that leads to multi-organ failure. Despite improvements in the possible therapies available, it remains a significant cause of morbidity and mortality among patients admitted to the Cardiac Intensive Care Unit (CICU). It remains unclear how age of the admitted patient may affect outcomes. Aim We investigated survival of CS patients admitted to a single quaternary North American center stratified by age. Methods: All CS patients aged 18 years and older admitted between January 2014 and December 2021 were identified from a prospective CICU admissions registry. Patients with durable left ventricular assist device (LVAD) and heart transplant (HT) were excluded, as were CICU readmissions during the index hospitalization. Patient characteristics, co-morbidities and outcome data were collected. Survival between age groups (<30, 30-40, 40-50, 50-60, 60-70 and >70 years old) was compared using Kaplan-Meier methods. A Cox proportional hazards model evaluating survival differences by age as a continuous variable was created and quantified the association between age and mortality with other covariates: sex, etiology, admission creatinine, sodium, lactate, white blood count (WBC) and mean arterial pressure (MAP). All analyses were right-censored for LVAD or HT. Results: 1284 CS patients were identified, with mean age 60 years, 71% male, 21% due to acute MI. In-hospital survival stratified by age was significantly different (figure), p(Log Rank<0.001). In the unadjusted model, increasing age led to an increased mortality, hazard ratio (HR) 1.029, p<0.001. In the adjusted model for mortality, age remained significant, HR 1.023, 95% confidence interval 1.015-1.030, p<0.001. Conclusion In a contemporary CICU registry, patients admitted with CS had higher mortality with advancing age. This should be a consideration in planning the use of potentially limited CICU resources.