Women Less Likely to Receive Lifesaving Treatment Following Cardiogenic Shock

Only half of patients experiencing cardiogenic shock survive, and women are less likely than men to receive lifesaving treatment, according to new research presented at the European Society of Cardiology’s Acute CardioVascular Care 2022. Cardiogenic shock is usually caused by a large heart attack and is a life-threatening condition in which the heart fails to pump enough blood to supply the body’s organs with sufficient oxygen.

Researchers investigated the differences in treatment and survival for men and women with a heart attack and cardiogenic shock. The study included all adults admitted between 2010 and 2017 at 2 highly specialized centers providing cardiogenic shock care. The centers provided care for two-thirds of the Danish population.

A total of 1716 patients with heart attack and cardiogenic shock were enrolled in the study. A quarter (26%) of the participants were women, who had an average age of 71 years compared with 66 years for the men. Follow-up data were extracted from medical records and the Danish National Patient Registry.

Hypertension and chronic obstructive pulmonary disease were more common among the women; otherwise, patient characteristics between the men and women were similar. At the time of cardiogenic shock, women and men had comparable blood pressure (mean: 82 mm Hg for both), heart rate (mean: 88 bpm for women vs 85 bpm for men), p-lactate (median: 5.2 mM for women vs 5.5 mM for men), and left ventricular ejection fraction (median: 30% for both).

“The women and men in our study had similar clinical characteristics when they developed cardiogenic shock after a heart attack,” study author Dr Sarah Holle of Copenhagen University Hospital, Rigshospitalet, Denmark, said in a statement. “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.”

According to the research, women were more likely to be admitted initially at a local hospital (41% vs 30% men) and more men presented with out-of-hospital cardiac arrest (48% vs 25% women).

Holle pointed to the growing evidence that nonspecific symptoms, such as shortness of breath, nausea, fatigue, and pain in the back, jaw, or neck, are more common among women experiencing acute heart problems compared with men. These nonspecific symptoms may explain why women were more likely to be initially admitted to a local hospital than a specialist hospital.

Regarding treatment and outcomes, the researchers found:

• Women were less likely to receive mechanical circulatory support (19% vs 26%); acute revascularization, such as percutaneous coronary intervention and coronary artery bypass graft (83% vs 88%); and mechanical ventilation (67% vs 82%)
• 30 days after the event, only 38% of women were alive vs 50% of men
• 8.5 years after the event only 27% of women were alive vs 39% of men

“Treatment guidelines are based on studies which primarily enrolled men,” Holle said. “Further research is needed to determine whether women and men with cardiogenic shock might benefit from different interventions.”

The findings echo similar results from past research funded by the British Heart Foundation, which found that even when women were given a test that boosted their rates of diagnosis for a heart attack, they were still half as likely as men to receive recommended treatments.

Reference

Holle S, Josiassen J, Helgestad OKL, et al. Sex differences in treatment and outcome of patients with cardiogenic shock complicating acute myocardial infarction. Presented at: ESC Acute CardioVascular Care 2022; virtual.