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Impact of Age on Outcomes in Patients With Cardiogenic Shock

Manreet Kanwar1, Katherine L Thayer2, Arthur Reshad Garan3

  • 1Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, United States.

Frontiers in Cardiovascular Medicine
|August 9, 2021
PubMed

Insights

Advanced age increases mortality risk in cardiogenic shock (CS). Older patients with CS have worse outcomes, regardless of shock severity, highlighting age as a key factor in treatment decisions.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Critical Care Medicine

Background:

  • Cardiovascular emergencies, particularly cardiogenic shock (CS), are associated with poorer outcomes in older adults.
  • The impact of advanced age on mortality in CS, considering support device use and shock severity, requires further investigation.

Purpose of the Study:

  • To determine the association between age, use of mechanical circulatory support devices, and shock severity on mortality in patients experiencing cardiogenic shock.
  • To analyze how age influences outcomes across different stages of CS severity and with various support interventions.

Main Methods:

  • Retrospective review of 1,412 patients from the Cardiogenic Shock Work Group (CSWG) registry across 8 US sites (2016-2019).
  • Patients were stratified by age quintiles and Society for Cardiovascular Angiography & Interventions (SCAI) shock severity stages.
  • Data on comorbidities, device support (ECMO, Impella, IABP), and in-hospital survival were analyzed.

Main Results:

  • Older patients (>73 years) exhibited a higher comorbidity burden, including diabetes, hypertension, and coronary artery disease.
  • Overall in-hospital survival was 69%, with a significant incremental decrease in survival corresponding with advancing age (p < 0.001).
  • Increased age was independently associated with higher mortality across all SCAI shock stages (C, D, E), irrespective of the underlying etiology of CS.

Conclusions:

  • Increasing age is a significant independent predictor of higher in-hospital mortality in patients with cardiogenic shock, across all severity stages.
  • Age should be a prioritized factor, alongside other comorbidities, when selecting patients for mechanical support devices in CS management.
  • These findings underscore the need for age-specific considerations in risk stratification and treatment strategies for cardiogenic shock.

Keywords:
agecardiogenic shockmechanical circulatory supportmortalityoutcome

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