Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 23:8:688098.
doi: 10.3389/fcvm.2021.688098. eCollection 2021.

Impact of Age on Outcomes in Patients With Cardiogenic Shock

Manreet Kanwar  1 , Katherine L Thayer  2 , Arthur Reshad Garan  3 , Jaime Hernandez-Montfort  4 , Evan Whitehead  5 , Claudius Mahr  6 , Shashank S Sinha  7 , Esther Vorovich  8 , Neil M Harwani  2 , Elric Zweck  2 , Jacob Abraham  9 , Daniel Burkhoff  10 , Navin K Kapur  2
Affiliations

Impact of Age on Outcomes in Patients With Cardiogenic Shock

Manreet Kanwar et al. Front Cardiovasc Med. .

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.

Keywords: age; cardiogenic shock; mechanical circulatory support; mortality; outcome.

PubMed Disclaimer

Conflict of interest statement

MK and JH-M are consultants for Abiomed Inc. CM is a consultant for Abbott Laboratories, Abiomed Inc., Medtronic, and Syncardia. AG is a consultant for Abiomed and NuPulseCV. He has received research support from Abbott and Verantos. DB reports an unrestricted, educational grant from Abiomed Inc. to Cardiovascular Research Foundation. JA was a consultant for Abbott Laboratories, Abiomed Inc. JH-M receives speaker honoraria and a research grant from Abiomed Inc. NK receives consulting/speaker honoraria and institutional grant support from: Abbott Laboratories, Abiomed Inc., Boston Scientific, Medtronic, LivaNova, MDStart, and Precardia. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Association between age and mortality by etiology of cardiogenic shock. MI, myocardial infarction; HF, heart failure; n.s., not significant statistically.
Figure 2
Figure 2
Association between age and mortality by severity of cardiogenic shock as defined by the Society of Cardiovascular Angiography and Intervention (SCAI) classification.
Figure 3
Figure 3
Association between in-hospital mortality and use of temporary mechanical circulatory support devices.
See this image and copyright information in PMC

References

    1. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. . Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. (2017) 136:e232–68. 10.1161/CIR.0000000000000525 - DOI - PubMed
    1. Garan AR, Kirtane A, Takayama H. Redesigning care for patients with acute myocardial infarction complicated by cardiogenic shock: the shock team. JAMA Surg. (2016) 151:684–5. 10.1001/jamasurg.2015.5514 - DOI - PubMed
    1. Mendiratta P, Wei JY, Gomez A, Podrazik P, Riggs AT, Rycus P, et al. . Cardiopulmonary resuscitation requiring extracorporeal membrane oxygenation in the elderly: a review of the extracorporeal life support organization registry. ASAIO J. (2013) 59:211–5. 10.1097/MAT.0b013e31828fd6e5 - DOI - PubMed
    1. Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM, et al. . Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant. (2013) 32:106–11. 10.1016/j.healun.2012.10.005 - DOI - PubMed
    1. Tehrani BN, Rosner CM, Batchelor WB. Evolving paradigms in cardiogenic shock care. Aging. (2019) 11:4303–4. 10.18632/aging.102075 - DOI - PMC - PubMed