"Impact of age on management and prognosis of resuscitated sudden cardiac death patients"

Jordi Sans Roselló; Maria Vidal-Burdeus; Pablo Loma-Osorio; Alexandra Pons Riverola; Gil Bonet Pineda; Nabil El Ouaddi; Jaime Aboal; Albert Ariza Solé; Claudia Scardino; Cosme García-García; Estefanía Fernández-Peregrina; Alessandro Sionis

doi:10.1016/j.ijcha.2022.101036

"Impact of age on management and prognosis of resuscitated sudden cardiac death patients"

Int J Cardiol Heart Vasc. 2022 Apr 27:40:101036. doi: 10.1016/j.ijcha.2022.101036. eCollection 2022 Jun.

Affiliations

¹ Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain.
² Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón. Barcelona, Spain.
³ Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain.
⁴ Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
⁵ Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain.
⁶ Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
⁷ Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain.

Abstract

Background: Sudden cardiac death (SCD) has a great impact on healthcare due to cardiologic and neurological complications. Admissions of elderly people in Cardiology Intensive Care Units have increased. We assessed the impact of age in presentation, therapeutic management and in vital and neurological prognosis of SCD patients.

Methods: We carried out a retrospective, observational, multicenter registry of patients who were admitted with a SCD in 5 tertiary hospitals from January 2013 to December 2020. We divided our cohort into two groups (patients < 80 years and ≥ 80 years). Clinical, analytical and hemodynamic variables as well as in-hospital management were registered and compared between groups. The degree of neurological dysfunction, vital status at discharge and the influence of age on them were also reviewed.

Results: We reviewed 1160 patients admitted with a SCD. 11.3% were ≥ 80 years. Use of new antiplatelet agents, performance of a coronary angiography, use of pulmonary artery catheter and temperature control were less carried out in the elderly. Age, non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min, time to ROSC > 20 min and lactate > 2 mmol/L were independent predictors for in-hospital mortality. Non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min and time to ROSC > 20 min but not age were independent predictors for poor neurological outcomes.

Conclusions: Age determined a less aggressive management and it was associated with a worse vital prognosis in patients admitted with a SCD. Nevertheless, age was not associated with worse neurological outcomes.

Keywords: ADL, Activities of daily living; CA, Cardiac arrest; CAG, Coronary angiography; CCI, Charlson Comorbidity Index; CPC, Cerebral performance category; CPR, Cardiopulmonary resuscitation; EI-MV, Endotracheal intubation with mechanical ventilation; Elderly patients; NSE, Neuronal specific enolase; Neurological outcomes; ROSC, Recovery of spontaneous circulation; SCD, Sudden cardiac death; Sudden cardiac death; TC, Temperature control.