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Evaluating the Predictive Value of Frailty Scores on Mortality in Patients with Cardiogenic Shock Across the Age Spectrum.
Session:
SESSÃO DE POSTERS 10 - GERIATRIA CARDIOVASCULAR: MOSTRA-ME OS DADOS!
Speaker:
Andre Jorge Moniz Garcia
Congress:
CPC 2025
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.5 Cardiovascular Disease in the Elderly
Session Type:
Cartazes
FP Number:
---
Authors:
André Moniz Garcia; Inês Coutinho Dos Santos; João Presume; Ana Rita Bello; Jorge Ferreira; Catarina Brizido; Christopher Strong; António Tralhão; C. Santos-Jorge; Rui Miguel Gomes; Márcia Presume
Abstract
<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><u>Introduction</u></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Cardiogenic shock is a multifactorial syndrome affecting patients across all age groups with mortality rates that exceed 50% in several cohorts. Elderly individuals, due to their inherent frailty, are particularly susceptible. This study aims to evaluate differences in clinical characteristics and outcomes between younger and older patients with cardiogenic shock and assess the utility of frailty scores in predicting outcomes. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><u>Methods</u></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">This retrospective study analysed a cohort of cardiogenic shock patients from a single center, from 2017-2024, focusing on one-year mortality as the primary outcome. Predictive variables included demographic, clinical, and frailty data, incorporating the ECOG Performance Status (PS), Charlson Comorbidity Index (CCI), and Modified Frailty Index-11 (mF11). Univariate and multivariate analyses assessed the predictive value of these scores. Age and frailty were combined into a logistic regression model to evaluate their joint predictive capacity.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><u>Results</u></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">A total of 356 patients were included, with a mean age of 66 ± 16 years, 66.5% male, and a one-year mortality rate was 54.8%. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Mortality increased with age, reaching 66.0% in patients aged ≥70 years compared to 46.6% in younger patients (p = 0.002) (fig.1 and 2). Worse functional status was also associated with higher mortality; individuals with PS ≥2 had a one-year mortality rate of 68.9%, compared to 50.2% in those with PS ≤1 (fig.3 and 4).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Among frailty scores, PS independently predicted one-year mortality (HR1.272 [1.099–1.471]; p = 0.001), while CCI (HR 1.055 [0.979–1.139]; p=0.165) and mF11 (HR1.066 [0.988–1.150]; p = 0.101) were not significant. In a multivariate analysis adjusting for age, gender, SCAI class, troponin levels, cardiac arrest, and chronic kidney disease, PS remained a robust predictor (HR1.347 [1.142–1.588]; p<0.001, per unit increase).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">In patients aged ≥70 years, those with PS ≤1 had a one-year mortality rate of 61.2%, compared to 82.4% with PS >1. Combining age and PS into a logistic regression model yielded a significant association with one-year mortality (p < 0.001) and an AUROC of 0.691, indicating moderate discriminative ability.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><u>Conclusion:</u></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Age and frailty, particularly functional status as measured by ECOG PS, are critical predictors of mortality in cardiogenic shock. This study underscores the need to routinely integrate frailty assessments into risk models to refine prognostication and optimize care pathways in this critically ill population.</span></span></p>
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