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. 2024 Apr 3;13(7):2078.
doi: 10.3390/jcm13072078.

Frailty and In-Hospital Outcomes for Management of Cardiogenic Shock without Acute Myocardial Infarction

Dae Yong Park  1 , Yasser Jamil  2 , Yousif Ahmad  3 , Theresa Coles  4 , Hayden Barry Bosworth  4   5 , Nikhil Sikand  3 , Carlos Davila  3 , Golsa Babapour  3 , Abdulla A Damluji  6   7 , Sunil V Rao  8 , Michael G Nanna  3 , Marc D Samsky  3
Affiliations

Frailty and In-Hospital Outcomes for Management of Cardiogenic Shock without Acute Myocardial Infarction

Dae Yong Park et al. J Clin Med. .

Abstract

(1) Background: Cardiogenic shock (CS) is associated with high morbidity and mortality. Frailty and cardiovascular diseases are intertwined, commonly sharing risk factors and exhibiting bidirectional relationships. The relationship of frailty and non-acute myocardial infarction with cardiogenic shock (non-AMI-CS) is poorly described. (2) Methods: We retrospectively analyzed the National Inpatient Sample from 2016 to 2020 and identified all hospitalizations for non-AMI-CS. We classified them into frail and non-frail groups according to the hospital frailty risk score cut-off of 5 and compared in-hospital outcomes. (3) Results: A total of 503,780 hospitalizations for non-AMI-CS were identified. Most hospitalizations involved frail adults (80.0%). Those with frailty had higher odds of in-hospital mortality (adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 2.03-2.20, p < 0.001), do-not-resuscitate status, and discharge to a skilled nursing facility compared with those without frailty. They also had higher odds of in-hospital adverse events, such as acute kidney injury, delirium, and longer length of stay. Importantly, non-AMI-CS hospitalizations in the frail group had lower use of mechanical circulatory support but not rates of cardiac transplantation. (4) Conclusions: Frailty is highly prevalent among non-AMI-CS hospitalizations. Those accompanied by frailty are often associated with increased rates of morbidity and mortality compared to those without frailty.

Keywords: cardiogenic shock; frailty; non-acute myocardial infarction.

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Conflict of interest statement

Nanna MG: Dr. Nanna reports current research support from the American College of Cardiology Foundation supported by the George F. and Ann Harris Bellows Foundation, the Patient-Centered Outcomes Research Institute (PCORI), the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), and the National Institute on Aging/National Institutes of Health from R03AG074067 (GEMSSTAR award). Dr. Nanna also reports being a consultant for Heartflow and Merck. Coles T: Dr. Coles has research funding from Pfizer and Merck. Bosworth HB: Hayden Bosworth reports research funding through his institution from BeBetter Therapeutics, Boehringer Ingelheim, Esperion, Improved Patient Outcomes, Merck, NHLBI, Novo Nordisk, Otsuka, Sanofi, Veterans Administration, Elton John Foundation, Hilton Foundation, Pfizer. He also provides consulting services for Abbott, Esperion, Imatar, Novartis, Sanofi, Vidya, Walmart, and Webmed. He was also on the board of directors of Preventric Diagnostics. Ahmad Y: Dr. Ahmad is a Consultant for Cardiovascular Systems Inc. and Shockwave and serves on the Medical Advisory Board of Boston Scientific. Damluji AA: Dr. Damluji receives research funding from (1) the Pepper Scholars Program of the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the National Institute on Aging P30-AG021334; (2) mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute K23-HL153771; (3) The NIH National Institute of Aging R01-AG078153; (4) the Patient-Centered Outcomes Research Institute (PCORI). The rest of the authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of this study. Description: The flowchart illustrates the patient selection process used in this study. Abbreviations: AMI, acute myocardial infarction; NIS, National Inpatient Sample.
Figure 2
Figure 2
Comparison of in-hospital outcomes between non-AMI-CS in frailty versus no frailty. Description: The figure summarizes the key findings of this study. The vertical lines represent the aOR, while the perpendicular horizontal lines represent the 95% CI. aOR > 1 signifies that the odds of the particular outcome are higher in AMI-CS hospitalizations with frailty, and vice versa. Abbreviations: AMI, acute myocardial infarction; aOR, adjusted odds ratio; CI, confidence interval; CS, cardiogenic shock.
See this image and copyright information in PMC

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