Sex differences in patients with cardiogenic shock

Abstract

Aims Differences between female and male patients in clinical presentation, causes and treatment of cardiogenic shock (CS) are poorly understood. We aimed to investigate sex differences in presentation with and treatment of CS. Methods and results We analysed data of 978 patients presenting with CS to a tertiary care hospital between October 2009 and October 2017. Multivariable adjusted logistic/Cox regression models were fitted to investigate the association between sex and clinical presentation, use of treatments and 30 day mortality. Median age was 70 years (interquartile range 58-79 years), and 295 (30.2%) patients were female. After adjustment for multiple relevant confounders, female patients were more likely to be older [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.02-1.42, P = 0.027], but other relevant presentation characteristics did not differ between both sexes. Despite the similar presentation, female patients were less likely to be treated with percutaneous left ventricular assist devices (OR 0.78, 95% CI 0.64-0.94, P = 0.010), but more likely to be treated with catecholamines (OR 1.21, 95% CI 1.02-1.44, P = 0.033) or vasopressors (OR 1.26, 95% CI 1.05-1.50, P = 0.012). A 30 day mortality risk in female patients was as high as in male patients (hazard ratio 1.08, 95% CI 1.00-1.18, P = 0.091). Conclusions In this large, contemporary cohort, clinical presentation was comparable in female and male patients, and both sexes were associated with a comparably high mortality risk. Nevertheless, female patients received different treatment for CS and were most importantly less likely to be treated with percutaneous left ventricular assist devices.

Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center

“…Moreover, women are underrepresented, as the proportion of women included in previous series is relatively low (ranging from 25 to 45%) as it happened in our case. It is also remarkable that they are usually older and suffer from more comorbidities (9)(10)(11) which might be associated with a worse prognosis. Conversely, our cohort is quite balanced with respect to baseline characteristics and prognostic factors.…”

Sex‐related differences in cardiogenic shock: Can we do better in women?

“…theorized that percutaneous left ventricular assist devices have been used less frequently in women due to operators' hesitancy associated with their presumed anatomical challenges, such as small left ventricular cavity and smaller vessel size. 5 Overall, the current study not only highlights important findings related to sex differences in CS care and outcomes but also examines the interplay of sex with age and the etiology of CS (AMI vs. non-AMI). It is time to change the paradigm from identifying disparities to focusing on the subgroups at highest risk and implementing proven therapies and actionable strategies in those patients.…”

“…Sex differences in the use of MCS are also widely debated and may represent an important factor affecting bleeding hazards and overall outcomes in CS. Yan et al theorized that percutaneous left ventricular assist devices have been used less frequently in women due to operators' hesitancy associated with their presumed anatomical challenges, such as small left ventricular cavity and smaller vessel size 5 …”

Italian Association of Hospital Cardiologists Position Paper ‘Gender discrepancy: time to implement gender-based clinical management’

“…A potential reason hypothesized might be physicians’ reluctance to implant pLVAD, worried about higher complication risk in females due to their smaller body and thus vessel size, as pLVAD requires a large bore vessel access. 165 …”