Women less likely to receive treatment, more likely to die after cardiogenic shock
Women undergoing cardiogenic shock may be less likely to receive certain types of treatment than men and more likely to die within 30 days, according to research presented on March 19 at the European Society of Cardiology (ESC) Acute CardioVascular Care conference.
This was true even when the women had comparable blood pressure, heart rate, oxygen levels in the organs, and heart pump function, according to lead author Sarah Holle of Denmark’s Copenhagen University.
To arrive at this conclusion, the study’s authors examined medical records and mortality data for 1,716 heart attack patients who experienced cardiogenic shock between 2010 and 2017 and were admitted to one of two specialized centers in Denmark providing cardiogenic shock care. Twenty-six percent of the patients were women.
After experiencing a heart event and presenting at one of the centers in the study, 26% of the men received mechanical circulatory support versus 19% of the women. Additionally, 88% of the men versus 83% of the women received minimally invasive or surgical procedures to restore blood flow to blocked arteries, and 82% of men versus 67% of the women received mechanical ventilation.
The women in the study also had lower short- and long-term mortality rates than their male counterparts. Thirty days after the heart event, 50% of the men were still alive, compared with just 38% of the women. After 8.5 years, 39% of the men were still alive, compared with 27% of the women.
Multivariate analysis determined that even after controlling for factors such as age and whether the cardiac arrest took place in a hospital or not, female biological sex was still individually associated with the lower use of mechanical circulatory support as well as the overall mortality rate.
While the study was unable to examine the reasons behind particular clinical decisions, Holle highlighted that awareness about cardiogenic shock in women—or lack thereof—could play a role.
“This was a retrospective study so it is difficult to know why clinicians made certain treatment decisions. But the findings indicate that greater awareness among health professionals that women have heart attacks and may develop cardiogenic shock could be a step towards equitable management and outcomes,” Holle said in an ESC press release about the study.
One possible reason for the differences in treatment, she noted, could be that women may be more likely to have nonspecific symptoms—such as shortness of breath, nausea, vomiting, coughing, and fatigue—rather than chest pain.
“Increased recognition that women may have symptoms other than chest pain could minimize delays in diagnosis and treatment and potentially improve prognosis,” she said.