Impact of Age on Outcomes in Patients with Cardiogenic Shock

Abstract

<h3>Purpose</h3> Advanced age is associated with poor outcomes in cardiovascular emergencies. We sought to determine the association of age, use of temporary mechanical circulatory support (t-MCS) devices and shock severity on inpatient mortality in cardiogenic shock (CS). <h3>Methods</h3> Outcomes in CS patients included in Cardiogenic Shock Work Group (CSWG) registry from 8 US sites between 2016 - 2019 were retrospectively reviewed. Patients were subdivided by age into quintiles as well as by Society for Cardiovascular Angiography & Interventions (SCAI) shock severity. Etiology of CS, comorbidities, t-MCS use, labs and hemodynamics were reviewed across the quintiles in each SCAI stage. <h3>Results</h3> We reviewed 1,412 CS patients with a mean age of 59.9±14.8 years, including 27.5% females and 273 patients > 73 years of age. Acute MI was the etiology of CS in nearly 40% of patients. Older patients had significantly higher comorbidity burden including diabetes, hypertension and coronary artery disease. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was used in 332 (23%) patients, Impella in 410 (29%) and intra-aortic balloon pump (IABP) in 770 (54%) patients. Overall in-hospital survival was 69%, which incrementally decreased with advancing age (p<0.001). Higher age was associated with higher mortality across all SCAI stages (p=0.003 for SCAI stage C; p<0.001 for SCAI stage D; p=0.005 for SCAI stage E), regardless of etiology (p<0.001). <h3>Conclusion</h3> Increasing age is associated with higher in-hospital mortality in cardiogenic shock across all stages of shock severity. Patient selection for use of t-MCS should focus on multiple factors, with prioritization of advanced age and early establishment of goals of care.