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Sex-related differences in patients presenting with heart failure-related cardiogenic shock
Jonas Sundermeyer1,2, Caroline Kellner1,2,3, Benedikt N Beer1,2
1Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
Insights
This study found that while women with heart failure-related cardiogenic shock (HF-CS) present differently than men, treatment use and 30-day mortality rates are similar. Further research is needed for sex-tailored treatments in HF-CS.
Area of Science:
- Cardiology
- Sex Differences in Medicine
- Critical Care Medicine
Background:
- Heart failure-related cardiogenic shock (HF-CS) is a critical condition with limited understanding of sex-based disparities.
- Existing research lacks comprehensive data on how clinical presentation, treatment, and outcomes differ between men and women experiencing HF-CS.
Purpose of the Study:
- To investigate sex-related differences in the clinical presentation of HF-CS.
- To compare the utilization of treatments for HF-CS between women and men.
- To analyze potential differences in 30-day mortality risk associated with sex in HF-CS patients.
Main Methods:
- An international observational study involving 1030 patients with HF-CS (excluding acute myocardial infarction) across 16 centers from 2010-2021.
- Logistic and Cox regression models were employed to evaluate differences in clinical characteristics, treatment administration, and 30-day mortality between sexes.
Main Results:
- Women with HF-CS were generally older, less likely to have prior heart failure history or cardiovascular risk factors, and presented with less severe left ventricular dysfunction and renal impairment compared to men.
- Despite these demographic and clinical differences, the severity of cardiogenic shock and the application of treatments were comparable between sexes.
- Female sex was not identified as an independent predictor of 30-day mortality, with rates of 53.0% in women versus 50.8% in men (adjusted HR 0.94, 95% CI 0.75-1.19).
Conclusions:
- Significant sex disparities exist in the risk factors and initial presentation of HF-CS.
- Current treatment approaches and overall 30-day mortality rates for HF-CS are similar in both women and men.
- Future research should explore sex-specific treatment strategies to potentially improve outcomes in HF-CS, considering observed differences in risk factors and presentation.
Background:
Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS.
Methods:
In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS.
Results:
N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75-1.19).
Conclusions:
In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS.
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