Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

Abstract

Background Timely management of acute myocardial infarction (AMI) and acute stroke has undergone impressive progress during the last decade. However, it is currently unknown whether both sexes have profited equally from improved strategies. We sought to analyze sex-specific temporal trends in intensive care unit (ICU) admission and mortality in younger patients presenting with AMI or stroke in Switzerland. Methods Retrospective analysis of temporal trends in 16,954 younger patients aged 18 to ≤ 52 years with AMI or acute stroke admitted to Swiss ICUs between 01/2008 and 12/2019. Results Over a period of 12 years, ICU admissions for AMI decreased more in women than in men (− 6.4% in women versus − 4.5% in men, p < 0.001), while ICU mortality for AMI significantly increased in women (OR 1.2 [1.10–1.30], p = 0.032), but remained unchanged in men (OR 0.99 [0.94–1.03], p = 0.71). In stroke patients, ICU admission rates increased between 3.6 and 4.1% per year in both sexes, while ICU mortality tended to decrease only in women (OR 0.91 [0.85–0.95, p = 0.057], but remained essentially unaltered in men (OR 0.99 [0.94–1.03], p = 0.75). Interventions aimed at restoring tissue perfusion were more often performed in men with AMI, while no sex difference was noted in neurovascular interventions. Conclusion Sex and gender disparities in disease management and outcomes persist in the era of modern interventional neurology and cardiology with opposite trends observed in younger stroke and AMI patients admitted to intensive care. Although our study has several limitations, our data suggest that management and selection criteria for ICU admission, particularly in younger women with AMI, should be carefully reassessed. Graphical Abstract

Sex differences in the use of mechanical ventilation in a neurointensive care population: a retrospective study

“…Also in the group of burn patients, sex had no influence on ICU mortality [21]. On the contrary, there are more data regarding the reduced use of interventions and ICU resources for women with cardiovascular disease in comparison with men: women are less likely to receive a revascularization for cardiovascular disease also in Switzerland [2,22]. It has also been described that women are less likely to receive a tracheostomy [23], but this was not the case in our case series.…”

“…While our group reported difference regardless of severity score in the use of invasive disease specific treatments for intracranial bleeding (women received less insertions of external ventricular drainage despite same size of the ventricles and same neurology) [30], no differences where observed in our institution regarding treatment for intracranial tumors and SAH [31,32]. The gender gap could have been narrowed thanks to guideline directed therapies [22].…”

Sex differences in the SOFA score of ICU patients with sepsis or septic shock: a nationwide analysis

“…Over the last decade, gender medicine, encompassing both sex and gender, has increasingly gained interest in critical care research [ 5 , 6 ]. Recent research has aimed to investigate sex and gender differences in overall physiology, disease pathogenesis, provision of ICU resources, and outcomes [ 3 , 7 , 8 ]. Biological differences within the immune response and its modification by sex steroids have been discussed as a potential contributor to the increased susceptibility to infection and sepsis described in men [ 6 , 9 ].…”

Sex and gender differences in intensive care medicine

“…Over the last years, sex and gender differences in diagnosis, clinical care, and outcomes have become an increasing concern in medicine and critical care research [ 1 , 2 ]. Inequalities in medical care were first described via several landmark publications in the early 1990s which revealed that women often received inequitable treatment compared to men, often resulting in worse outcomes.…”