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Published on: June 12, 2021
Sex difference in outcomes and management of cardiogenic shock: A systematic review and meta-analysis
Andrew Takla1, Mostafa Reda Mostafa1, Mohamed Magdi Eid1
1Rochester Regional Health/Unity Hospital, Rochester, New York, USA.
Insights
Men with cardiogenic shock (CS) have lower mortality rates compared to women. Addressing management disparities is essential to improve outcomes for all patients with CS.
Area of Science:
- Cardiology
- Critical Care Medicine
- Sex Differences in Medicine
Background:
- Cardiogenic shock (CS) presents significant morbidity and mortality.
- Existing data on sex-based differences in CS outcomes and management are limited.
- This study aims to elucidate sex-specific outcomes in cardiogenic shock.
Purpose of the Study:
- To investigate sex differences in cardiogenic shock outcomes.
- To compare mortality rates between males and females experiencing CS.
- To analyze differences in management strategies and complications based on sex.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Comprehensive literature search across MEDLINE/PubMed, EMBASE, and Cochrane databases until December 2022.
- Inclusion of 24 studies with a total of 1,567,660 patients.
Main Results:
- Males with CS exhibited lower in-hospital (RR 0.88) and 1-year mortality (RR 0.90) compared to females.
- Males were more likely to receive percutaneous coronary intervention (RR 1.21) and intra-aortic balloon pump placement (RR 1.21).
- Males had higher risks of arrhythmias but lower risks of acute kidney injury during hospitalization.
Conclusions:
- Men experience a lower risk of all-cause mortality in cardiogenic shock.
- Significant disparities in CS management exist between sexes.
- Targeted interventions are necessary to improve outcomes for women with cardiogenic shock.
Background:
Cardiogenic shock (CS) is associated with significant morbidity and mortality. Sex differences in the outcomes and management of cardiogenic shock are not well established. The primary objective of this study is to investigate the differences inik cardiogenic shock outcomes between males and females.
Methods:
A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Studies were searched via the MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to December 2022.
Results:
The analysis included 24 studies comprising 1,567,660 patients. Compared to females, males with CS had a significantly lower risk of in-hospital all-cause mortality (risk ratio [RR] 0.88, 95 % confidence interval [CI] 0.85-0.90, p < 0.001) and 1-year mortality (RR 0.90, 95 % CI 0.89-0.92, p < 0.001). Males were more likely to undergo percutaneous coronary intervention (RR 1.21, 95 % CI 1.13-1.31, p < 0.0001) and intra-aortic balloon pump placement (RR 1.21, 95 % CI 1.11-1.32, p < 0.0001), with no significant sex differences in the use of extracorporeal membrane oxygenation or Impella. During the index hospitalization, males were at higher risk of arrhythmias (RR 1.18, 95 % CI 1.05-1.34, p = 0.003) and less likely to develop acute kidney injury (RR 0.86, 95 % CI 0.79-0.94, p < 0.001).
Conclusion:
Men have a lower all-cause mortality risk in cardiogenic shock. Addressing disparities in management is crucial for improving CS outcomes, especially for women.
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