Abstract
Background: Advanced age is associated with poor outcomes in cardiovascular emergencies. We sought to determine the association of age, use of support devices and shock severity on mortality in cardiogenic shock (CS).Methods: Characteristics and outcomes in CS patients included in the Cardiogenic Shock Work Group (CSWG) registry from 8 US sites between 2016 and 2019 were retrospectively reviewed. Patients were subdivided by age into quintiles and Society for Cardiovascular Angiography & Interventions (SCAI) shock severity.Results: We reviewed 1,412 CS patients with a mean age of 59.9 ± 14.8 years, including 273 patients > 73 years of age. Older patients had significantly higher comorbidity burden including diabetes, hypertension and coronary artery disease. Veno-arterial extracorporeal membrane oxygenation was used in 332 (23%) patients, Impella in 410 (29%) and intra-aortic balloon pump 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).Conclusion: Increasing age is associated with higher in-hospital mortality in CS across all stages of shock severity. Hence, in addition to other comorbidities, increasing age should be prioritized during patient selection for device support in CS.
Highlights
Cardiogenic shock (CS) is associated with high in-hospital mortality despite increasing use of temporary mechanical circulatory support devices (t-MCS) [1,2,3]
We describe the association between age, severity of CS and use of t-MCS devices in one of the largest multi-center registries representing real-world CS patients in the contemporary era
Higher Society for Cardiovascular Angiography and Intervention (SCAI) shock stages were associated with increased mortality risk in each age group, while older patients were more likely to die at each level of shock severity
Summary
Cardiogenic shock (CS) is associated with high in-hospital mortality despite increasing use of temporary mechanical circulatory support devices (t-MCS) [1,2,3]. The decision to place an older patient on t-MCS needs to consider their baseline functional status, comorbidities, physiological reserve and goals of care in a heightened fashion [12, 13]. Since these are not well-studied, programs often choose somewhat arbitrary upper age limits for t-MCS use for CS patients at their sites [6]. We sought to determine the association of age, use of support devices and shock severity on mortality in cardiogenic shock (CS)
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