The adrenal gland secretes a variety of hormones that regulate physiological functions,and adrenal lesions can lead to insidious or sudden onset diseases that are easily misdiagnosed.Recently,several young patients wi...The adrenal gland secretes a variety of hormones that regulate physiological functions,and adrenal lesions can lead to insidious or sudden onset diseases that are easily misdiagnosed.Recently,several young patients with unknown sudden and refractory cardiogenic shock or cardiac arrest(CA)were successfully treated in our emergency department by the application of venoarterial extracorporeal membrane oxygenation(VA-ECMO).These life-threatening conditions were finally determined to be caused by adrenal lesions,which highlight the bridging role of VA-ECMO.[1]展开更多
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...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.展开更多
BACKGROUND As a result of improved and novel treatment strategies,the spectrum of patients with cardiovascular disease is consistently changing.Overall,those patients are typically older and characterized by increased...BACKGROUND As a result of improved and novel treatment strategies,the spectrum of patients with cardiovascular disease is consistently changing.Overall,those patients are typically older and characterized by increased burden with comorbidities.Limited data on the prognostic impact of age in cardiogenic shock(CS)is available.Therefore,this study investigates the prognostic impact of age in patients with CS.METHODS From 2019 to 2021,consecutive patients with CS of any cause were included.The prognostic value of age(i.e.,60-80 years and>80 years)was investigated for 30-day all-cause mortality.Spearman’s correlations,Kaplan-Meier analyses,as well as multivariable Cox proportional regression analyses were performed for statistics.Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction(AMI).RESULTS 223 CS patients were included with a median age of 77 years(interquartile range:69-82 years).No significant difference in 30-day all-cause mortality was observed for both age-groups(54.6%vs.63.4%,log-rank P=0.169;HR=1.273,95%CI:0.886-1.831,P=0.192).In contrast,when analyzing subgroups stratified by CS-etiology,AMI-related CS patients of the group>80 years showed an increased risk of 30-day all-cause mortality(78.1%vs.60.0%,log-rank P=0.032;HR=1.635,95%CI:1.000-2.673,P=0.050),which was still evident after multivariable adjustment(HR=2.072,95%CI:1.174-3.656,P=0.012).CONCLUSIONS Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology.However,increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.展开更多
基金Ruiyi Emergency Medical Research Fund(2021-22)Science and Technology Innovation Program of Hunan Province(2020SK53707)。
文摘The adrenal gland secretes a variety of hormones that regulate physiological functions,and adrenal lesions can lead to insidious or sudden onset diseases that are easily misdiagnosed.Recently,several young patients with unknown sudden and refractory cardiogenic shock or cardiac arrest(CA)were successfully treated in our emergency department by the application of venoarterial extracorporeal membrane oxygenation(VA-ECMO).These life-threatening conditions were finally determined to be caused by adrenal lesions,which highlight the bridging role of VA-ECMO.[1]
基金supported by National Heart Foundation(NHF)Fellowshipsupported by a National Health and Medical Research Council(NHMRC)+4 种基金a NHF Post Graduate Scholarshipssupported by a NHMRC Early Career Fellowshipa NHF Future Leader Fellowshipsupported by an NHMRC postgraduate scholarshipsupported by an NHMRC Senior Principal Research Fellowship。
文摘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.
文摘BACKGROUND As a result of improved and novel treatment strategies,the spectrum of patients with cardiovascular disease is consistently changing.Overall,those patients are typically older and characterized by increased burden with comorbidities.Limited data on the prognostic impact of age in cardiogenic shock(CS)is available.Therefore,this study investigates the prognostic impact of age in patients with CS.METHODS From 2019 to 2021,consecutive patients with CS of any cause were included.The prognostic value of age(i.e.,60-80 years and>80 years)was investigated for 30-day all-cause mortality.Spearman’s correlations,Kaplan-Meier analyses,as well as multivariable Cox proportional regression analyses were performed for statistics.Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction(AMI).RESULTS 223 CS patients were included with a median age of 77 years(interquartile range:69-82 years).No significant difference in 30-day all-cause mortality was observed for both age-groups(54.6%vs.63.4%,log-rank P=0.169;HR=1.273,95%CI:0.886-1.831,P=0.192).In contrast,when analyzing subgroups stratified by CS-etiology,AMI-related CS patients of the group>80 years showed an increased risk of 30-day all-cause mortality(78.1%vs.60.0%,log-rank P=0.032;HR=1.635,95%CI:1.000-2.673,P=0.050),which was still evident after multivariable adjustment(HR=2.072,95%CI:1.174-3.656,P=0.012).CONCLUSIONS Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology.However,increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.
