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Published on: June 12, 2021
Sex-Related Differences in Patient Characteristics, Hemodynamics, and Outcomes of Cardiogenic Shock: INOVA-SHOCK
Kelly C Epps1, Behnam N Tehrani1, Carolyn Rosner1
1Inova Heart and Vascular Institute, Falls Church, Virginia.
Insights
In patients with cardiogenic shock (CS) treated via a standardized team-based approach (STBA), women presented with higher acuity but experienced similar mortality and adverse events compared to men. This suggests STBA may mitigate historical sex-based outcome disparities in CS.
Area of Science:
- Cardiology
- Clinical Medicine
- Sex Differences in Health
Background:
- Limited understanding of sex-related disparities in cardiogenic shock (CS) outcomes.
- Investigating outcomes within a standardized team-based approach (STBA) is crucial.
Purpose of the Study:
- To evaluate sex-based differences in outcomes for patients with CS.
- To assess the impact of STBA on mitigating potential sex disparities in CS patients.
Main Methods:
- Retrospective analysis of 520 consecutive CS patients (acute myocardial infarction [AMI] or heart failure [HF]) from January 2017 to December 2019.
- Examination of in-hospital mortality, major adverse cardiac events, 30-day mortality, bleeding, vascular complications, and stroke stratified by sex and CS phenotype.
- Statistical analysis to identify sex-related differences and independent predictors of outcomes.
Main Results:
- Women with AMI-CS and HF-CS presented with higher acuity and cardiac arrest rates, respectively.
- No significant sex differences in in-hospital mortality or 1-year survival were observed for either AMI-CS or HF-CS.
- Women with HF-CS had higher rates of major bleeding and vascular complications, but female sex was not an independent predictor.
Conclusions:
- STBA may mitigate historical sex-based outcome disparities in CS patients, as women experienced similar mortality despite higher acuity.
- Further research is warranted to confirm the effectiveness of STBA in addressing sex differences in CS.
- Sex-specific considerations within STBA may still be necessary for complications like bleeding and vascular events.
Background:
Little is known about sex-related differences in outcomes of patients with cardiogenic shock (CS) treated within a standardized team-based approach (STBA).
Methods:
We evaluated 520 consecutive patients (151 women and 369 men) with CS due to acute myocardial infarction (AMI) and heart failure (HF) in a single-center registry (January 2017-December 2019) and examined outcomes according to sex and CS phenotype. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiac events, 30-day mortality, major bleeding, vascular complications, and stroke.
Results:
Women with AMI-CS had higher baseline acuity (CardShock score: female [F]: 5.5 vs male [M]: 4.0; P = .04). Women with HF-CS more often presented with cardiac arrest (F: 12.4% vs M: 2.4%; P< .01) and had higher rates of vasopressor use (F: 70.8% vs M: 58.0%; P = .04) and mechanical circulatory support (F: 46.1% vs M: 32.5%; P = .04). There were no sex-related differences in in-hospital mortality for AMI-CS (F: 45.2% vs M: 36.9%; P = .28) and HF-CS (F: 28.1% vs M: 24.5%; P = .56). Women with HF-CS experienced higher rates of major bleeding (F: 25.8% vs M: 13.7%; P = .02) and vascular complications (F: 15.7% vs M: 6.1%; P = .01). However, female sex was not an independent predictor of these complications. No sex differences in survival were noted at 1 year.
Conclusions:
Within an STBA, although women with AMI-CS and HF-CS presented with higher acuity, they experienced similar in-hospital mortality, major adverse cardiac events, 30-day mortality, stroke, and 30-day readmissions as men. Further research is needed to better understand the extent to which historical differences in CS outcomes can be mitigated by an STBA.
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