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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Sex Differences in Characteristics, Resource Utilization, and Outcomes of Cardiogenic Shock: Data From the Critical
Lori B Daniels1, Nicholas Phreaner1, David D Berg2
1Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla (L.B.D., N.P.).
Insights
Women with heart failure-related cardiogenic shock (HF-CS) experienced shorter hospital stays but higher mortality than men. Further research is needed to understand and eliminate these sex-based outcome disparities in HF-CS.
Area of Science:
- Cardiology
- Critical Care Medicine
- Sex Differences Research
Background:
- Cardiovascular diseases exhibit known sex disparities in management and outcomes.
- Limited data exists on sex-based differences in cardiogenic shock (CS).
Purpose of the Study:
- To investigate sex-related differences in the characteristics, resource utilization, and outcomes of patients experiencing cardiogenic shock.
Main Methods:
- Utilized data from the Critical Care Cardiology Trials Network (35 North American centers, 2018-2022).
- Stratified CS patients into CS post-acute myocardial infarction and heart failure-related CS (HF-CS).
- Employed multivariable logistic regression for analysis.
Main Results:
- Among 3923 CS patients (32% female), women with HF-CS had shorter CICU and hospital stays but received less pulmonary artery catheterization and mechanical circulatory support.
- Women with HF-CS experienced higher in-hospital mortality (34% vs. 23%) even after adjusting for confounders.
- No significant sex differences were observed in CS post-acute myocardial infarction regarding interventions or mortality.
Conclusions:
- Women with HF-CS showed lower utilization of key interventions and higher mortality compared to men, irrespective of age, illness severity, or comorbidities.
- Identified need to explore reasons for treatment decision variations to address outcome gaps in HF-CS.
Background:
Sex disparities exist in the management and outcomes of various cardiovascular diseases. However, little is known about sex differences in cardiogenic shock (CS). We sought to assess sex-related differences in the characteristics, resource utilization, and outcomes of patients with CS.
Methods:
The Critical Care Cardiology Trials Network is a multicenter registry of advanced cardiac intensive care units (CICUs) in North America. Between 2018 and 2022, each center (N=35) contributed annual 2-month snapshots of consecutive CICU admissions. Patients with CS were stratified as either CS after acute myocardial infarction or heart failure-related CS (HF-CS). Multivariable logistic regression was used for analyses.
Results:
Of the 22 869 admissions in the overall population, 4505 (20%) had CS. Among 3923 patients with CS due to ventricular failure (32% female), 1235 (31%) had CS after acute myocardial infarction and 2688 (69%) had HF-CS. Median sequential organ failure assessment scores did not differ by sex. Women with HF-CS had shorter CICU lengths of stay (4.5 versus 5.4 days; P<0.0001) and shorter overall lengths of hospital stay (10.9 versus 12.8 days; P<0.0001) than men. Women with HF-CS were less likely to receive pulmonary artery catheters (50% versus 55%; P<0.01) and mechanical circulatory support (26% versus 34%; P<0.0001) compared with men. Women with HF-CS had higher in-hospital mortality than men, even after adjusting for age, illness severity, and comorbidities (34% versus 23%; odds ratio, 1.76 [95% CI, 1.42-2.17]). In contrast, there were no significant sex differences in utilization of advanced CICU monitoring and interventions, or mortality, among patients with CS after acute myocardial infarction.
Conclusions:
Women with HF-CS had lower use of pulmonary artery catheters and mechanical circulatory support, shorter CICU lengths of stay, and higher in-hospital mortality than men, even after accounting for age, illness severity, and comorbidities. These data highlight the need to identify underlying reasons driving the differences in treatment decisions, so outcomes gaps in HF-CS can be understood and eliminated.
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