Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock

Xiaoman Xiao; Jason E Bloom; Emily Andrew; Luke P Dawson; Ziad Nehme; Michael Stephenson; David Anderson; Himawan Fernando; Samer Noaman; Shelley Cox; William Chan; David M Kaye; Karen Smith; Dion Stub

doi:10.26599/1671-5411.2023.01.004

Volume 20 Issue 1

Jan. 2023

Turn off MathJax

Article Contents

Article Navigation > Journal of Geriatric Cardiology > 2023 > 20(1): 1-10

Please cite this article as: Xiao X, Bloom JE, Andrew E, Dawson LP, Nehme Z, Stephenson M, Anderson D, Fernando H, Noaman S, Cox S, Chan W, Kaye DM, Smith K, Stub D. Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock. J Geriatr Cardiol 2023; 20(1): 1−10. DOI: 10.26599/1671-5411.2023.01.004

Citation:

Please cite this article as: Xiao X, Bloom JE, Andrew E, Dawson LP, Nehme Z, Stephenson M, Anderson D, Fernando H, Noaman S, Cox S, Chan W, Kaye DM, Smith K, Stub D. Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock. J Geriatr Cardiol 2023; 20(1): 1−10. DOI: 10.26599/1671-5411.2023.01.004

Citation:

PDF( 717 KB)

Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock

doi: 10.26599/1671-5411.2023.01.004

Xiaoman Xiao^{1, *},
Jason E Bloom^{1, 2, 3, 4, *},
Emily Andrew^{4, 5},
Luke P Dawson^{1, 4, 5},
Ziad Nehme^{4, 5, 6},
Michael Stephenson^{4, 5, 6},
David Anderson^{1, 4},
Himawan Fernando^{1, 2},
Samer Noaman^{1, 3},
Shelley Cox^{4, 5},
William Chan^{1, 3},
David M Kaye^{1, 2},
Karen Smith^{4, 5, 6
,
,},
Dion Stub^{1, 3, 4, 5
,
,}

1.
Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, Australia
2.
Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Australia
3.
Department of Cardiology, Western Health, Furlong Road, St Albans, Australia
4.
Ambulance Victoria, 31 Joseph Street, Blackburn, Australia
5.
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia
6.
Department of Paramedicine, Monash University, McMahons Road, Frankston, Australia

Funds: DS is supported by National Heart Foundation (NHF) Fellowship. JB, LD and SN are supported by a National Health and Medical Research Council (NHMRC) and a NHF Post Graduate Scholarships. ZN is supported by a NHMRC Early Career Fellowship and a NHF Future Leader Fellowship. EA is supported by an NHMRC postgraduate scholarship. DK is supported by an NHMRC Senior Principal Research Fellowship.

None
^*The authors contributed equally to this manuscript

More Information

Corresponding author: karen.smith@ambulance.vic.gov.au (Smith K); d.stub@alfred.org.au (Stub D)
Available Online: 2023-02-06
Publish Date: 2023-01-28

Abstract

Abstract

BACKGROUND The impact of age on outcomes in cardiogenic shock (CS) is poorly described in the pre-hospital setting. We assessed the impact of age on outcomes of patients treated by emergency medical services (EMS). METHODS This population-based cohort study included consecutive adult patients with CS transported to hospital by EMS. Successfully linked patients were stratified into tertiles by age (18-63, 64-77, and > 77 years). Predictors of 30-day mortality were assessed through regression analyses. The primary outcome was 30-day all-cause mortality. RESULTS A total of 3523 patients with CS were successfully linked to state health records. The average age was 68 ± 16 years and 1398 (40%) were female. Older patients were more likely to have comorbidities including pre-existing coronary artery disease, hypertension, dyslipidemia, diabetes mellitus, and cerebrovascular disease. The incidence of CS was significantly greater with increasing age (incidence rate per 100,000 person years 6.47 [95% CI: 6.1-6.8] in age 18-63 years, 34.34 [32.4-36.4] in age 64-77 years, 74.87 [70.6-79.3] in age > 77 years, P < 0.001). There was a step-wise increase in the rate of 30-day mortality with increasing age tertile. After adjustment, compared to the lowest age tertile, patients aged > 77 years had increased risk of 30-day mortality (adjusted hazard ratio = 2.26 [95% CI: 1.96-2.60]). Older patients were less likely to receive inpatient coronary angiography. CONCLUSION Older patients with EMS-treated CS have significantly higher rates of short-term mortality. The reduced rates of invasive interventions in older patients underscore the need for further development of systems of care to improve outcomes for this patient group.

FullText(HTML)

References(41)

References

[1]	Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv 2019; 94: 29−37.
[2]	van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136: e232−e268. doi: 10.1161/CIRCULATIONAHA.117.029532
[3]	Zeymer U, Vogt A, Zahn R, et al. Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Eur Heart J 2004; 25: 322−328. doi: 10.1016/j.ehj.2003.12.008
[4]	Acharya D. Predictors of outcomes in myocardial infarction and cardiogenic shock. Cardiol Rev 2018; 26: 255−266. doi: 10.1097/CRD.0000000000000190
[5]	Aissaoui N, Puymirat E, Juilliere Y, et al. Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction: the FAST-MI programme. Eur J Heart Fail 2016; 18: 1144−1152. doi: 10.1002/ejhf.585
[6]	Sutton AG, Finn P, Hall JA, et al. Predictors of outcome after percutaneous treatment for cardiogenic shock. Heart 2005; 91: 339−344. doi: 10.1136/hrt.2003.021691
[7]	Dzavik V, Sleeper LA, Cocke TP, et al. Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry. Eur Heart J 2003; 24: 828−837. doi: 10.1016/S0195-668X(02)00844-8
[8]	Rogers PA, Daye J, Huang H, et al. Revascularization improves mortality in elderly patients with acute myocardial infarction complicated by cardiogenic shock. Int J Cardiol 2014; 172: 239−241. doi: 10.1016/j.ijcard.2013.12.311
[9]	Bray J, Lim M, Cartledge S, et al. Comparison of the Victorian Emergency Minimum Dataset to medical records for emergency presentations for acute cardiovascular conditions and unspecified chest pain. Emerg Med Australas 2020; 32: 295−302. doi: 10.1111/1742-6723.13408
[10]	Nehme Z, Bernard S, Cameron P, et al. Using a cardiac arrest registry to measure the quality of emergency medical service care: decade of findings from the Victorian Ambulance Cardiac Arrest Registry. Circ Cardiovasc Qual Outcomes 2015; 8: 56−66. doi: 10.1161/CIRCOUTCOMES.114.001185
[11]	Bloom JE, Andrew E, Dawson LP, et al. Incidence and outcomes of nontraumatic shock in adults using emergency medical services in victoria, Australia. JAMA Netw Open 2022; 5: e2145179. doi: 10.1001/jamanetworkopen.2021.45179
[12]	Andrew E, Cox S, Smith K. Linking ambulance records with hospital and death index data to evaluate patient outcomes. Int J Gen Med 2022; 15: 567−572. doi: 10.2147/IJGM.S328149
[13]	Ostenfeld S, Lindholm MG, Kjaergaard J, et al. Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction. Resuscitation 2015; 87: 57−62. doi: 10.1016/j.resuscitation.2014.11.010
[14]	Sakamoto K, Matoba T, Mohri M, et al. Clinical characteristics and prognostic factors in acute coronary syndrome patients complicated with cardiogenic shock in Japan: analysis from the Japanese Circulation Society Cardiovascular Shock Registry. Heart Vessels 2019; 34: 1241−1249. doi: 10.1007/s00380-019-01354-9
[15]	Hongisto M, Lassus J, Tarvasmaki T, et al. Mortality risk prediction in elderly patients with cardiogenic shock: results from the CardShock study. ESC Heart Fail 2021; 8: 1398−1407. doi: 10.1002/ehf2.13224
[16]	Awad HH, Anderson FA Jr, Gore JM, et al. Cardiogenic shock complicating acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Am Heart J 2012; 163: 963−971. doi: 10.1016/j.ahj.2012.03.003
[17]	Kanwar M, Thayer KL, Garan AR, et al. Impact of age on outcomes in patients with cardiogenic shock. Front Cardiovasc Med 2021; 8: 688098. doi: 10.3389/fcvm.2021.688098
[18]	Delmas C, Roubille F, Lamblin N, et al. Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry. ESC Heart Fail 2022; 9: 408−419. doi: 10.1002/ehf2.13734
[19]	Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341: 625−634.
[20]	Dzavik V, Burton JR, Kee C, et al. Changing practice patterns in the management of acute myocardial infarction complicated by cardiogenic shock: elderly compared with younger patients. Can J Cardiol 1998; 14: 923−930.
[21]	Dauerman HL, Goldberg RJ, White K, et al. Revascularization, stenting, and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol 2002; 90: 838−842. doi: 10.1016/S0002-9149(02)02704-2
[22]	Tedesco JV, Williams BA, Wright RS, et al. Baseline comorbidities and treatment strategy in elderly patients are associated with outcome of cardiogenic shock in a community-based population. Am Heart J 2003; 146: 472−478. doi: 10.1016/S0002-8703(03)00308-9
[23]	Noaman S, Dinh D, Reid CM, et al. Comparison of outcomes of coronary artery disease treated by percutaneous coronary intervention in 3 different age groups (< 45, 46-65, and > 65 years). Am J Cardiol 2021; 152: 19−26. doi: 10.1016/j.amjcard.2021.05.002
[24]	Lim HS, Farouque O, Andrianopoulos N, et al. Survival of elderly patients undergoing percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock. JACC Cardiovasc Interv 2009; 2: 146−152. doi: 10.1016/j.jcin.2008.11.006
[25]	Damluji AA, Bandeen-Roche K, Berkower C, et al. Percutaneous coronary intervention in older patients with ST-segment elevation myocardial infarction and cardiogenic shock. J Am Coll Cardiol. 2019; 73: 1890-1900.
[26]	Bendz B, Aaberge L. Acute coronary syndromes in older patients: does older age matter? Lancet 2020; 396: 585-587.
[27]	Llao I, Ariza Sole A. Mortality in elderly patients with cardiogenic shock: why and how? Eur Heart J Acute Cardiovasc Care 2021; 10: 613-615.
[28]	Naidu SS, Baran DA, Jentzer JC, et al. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 2022; 79: 933−946.
[29]	Gual M, Albert-Sole A, Maarquez MG, et al. Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock. J Geriatr Cardiol 2020; 17: 604−611.
[30]	Sanchez-Salado JC, Burgos V, Ariza-Sole A, et al. Trends in cardiogenic shock management and prognostic impact of type of treating center. Rev Esp Cardiol (Engl Ed) 2020; 73: 546−553. doi: 10.1016/j.recesp.2019.10.009
[31]	Ariza-Sole A, Alegre O, Elola FJ, et al. Management of myocardial infarction in the elderly. Insights from Spanish Minimum Basic Data Set. Eur Heart J Acute Cardiovasc Care 2019; 8: 242−251.
[32]	Prasad A, Lennon RJ, Rihal CS, et al. Outcomes of elderly patients with cardiogenic shock treated with early percutaneous revascularization. Am Heart J 2004; 147: 1066−1070. doi: 10.1016/j.ahj.2003.07.030
[33]	Dauerman HL, Goldberg RJ, Malinski M, et al. Outcomes and early revascularization for patients > or = 65 years of age with cardiogenic shock. Am J Cardiol 2001; 87: 844−848. doi: 10.1016/S0002-9149(00)01524-1
[34]	Migliorini A, Moschi G, Valenti R, et al. Routine percutaneous coronary intervention in elderly patients with cardiogenic shock complicating acute myocardial infarction. Am Heart J 2006; 152: 903−908. doi: 10.1016/j.ahj.2005.12.030
[35]	Zeymer U, Hochadel M, Karcher AK, et al. Procedural Success Rates and Mortality in Elderly Patients With Percutaneous Coronary Intervention for Cardiogenic Shock. JACC Cardiovasc Interv 2019; 12: 1853−1859. doi: 10.1016/j.jcin.2019.04.027
[36]	Moghaddam N, van Diepen S, So D, et al. Cardiogenic shock teams and centres: a contemporary review of multidisciplinary care for cardiogenic shock. ESC Heart Fail 2021; 8: 988−998. doi: 10.1002/ehf2.13180
[37]	Basir MB, Kapur NK, Patel K, et al. Improved outcomes associated with the use of shock protocols: updates from the national cardiogenic shock initiative. Catheter Cardiovasc Interv 2019; 93: 1173−1183.
[38]	Tehrani BN, Truesdell AG, Sherwood MW, et al. Standardized Team-Based Care for Cardiogenic Shock. J Am Coll Cardiol 2019; 73: 1659−1669.
[39]	Lee F, Hutson JH, Boodhwani M, et al. Multidisciplinary code shock team in cardiogenic shock: a Canadian centre experience. CJC Open 2020; 2: 249−257. doi: 10.1016/j.cjco.2020.03.009
[40]	Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005; 294: 448−454. doi: 10.1001/jama.294.4.448
[41]	Taleb I, Koliopoulou AG, Tandar A, et al. Shock team approach in refractory cardiogenic shock requiring short-term mechanical circulatory support: a proof of concept. Circulation 2019; 140: 98−100. doi: 10.1161/CIRCULATIONAHA.119.040654