Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock
Xiaoman Xiao1
Jason E Bloom2
Emily Andrew3
Luke P Dawson4
Ziad Nehme5
Michael Stephenson5
David Anderson6
Himawan Fernando7
Samer Noaman8
Shelley Cox3
William Chan8
David M Kaye7
Karen Smith5
Dion Stub9
1.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia2.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia;Baker Heart and Diabetes Institute,75 Commercial Road,Melbourne,Australia;Department of Cardiology,Western Health,Furlong Road,St Albans,Australia;Ambulance Victoria,31 Joseph Street,Blackburn,Australia3.Ambulance Victoria,31 Joseph Street,Blackburn,Australia;School of Public Health and Preventive Medicine,Monash University,553 St Kilda Road,Melbourne,Australia4.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia;Ambulance Victoria,31 Joseph Street,Blackburn,Australia;School of Public Health and Preventive Medicine,Monash University,553 St Kilda Road,Melbourne,Australia5.Ambulance Victoria,31 Joseph Street,Blackburn,Australia;School of Public Health and Preventive Medicine,Monash University,553 St Kilda Road,Melbourne,Australia;Department of Paramedicine,Monash Uni-versity,McMahons Road,Frankston,Australia6.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia;Ambulance Victoria,31 Joseph Street,Blackburn,Australia7.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia;Baker Heart and Diabetes Institute,75 Commercial Road,Melbourne,Australia8.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia;Department of Cardiology,Western Health,Furlong Road,St Albans,Australia9.Department of Cardiology,Alfred Health,55 Commercial Road,Melbourne,Australia;Department of Cardiology,Western Health,Furlong Road,St Albans,Australia;Ambulance Victoria,31 Joseph Street,Blackburn,Australia;School of Public Health and Preventive Medicine,Monash University,553 St Kilda Road,Melbourne,Australia
摘要：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 dis-ease, 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.
机标关键词：servicesclinicalcardiogenicdeterminantemergencymeasuresmedicaloutcomes
论文发表日期：2023-01-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：10( 1-10 )