Cardiogenic shock is a life-threatening condition in which the heart suddenly fails to pump enough blood to supply the body's organs with sufficient oxygen. It is usually caused by a large heart attack. It is estimated that up to 10 per cent of patients with heart attacks affecting a large area of the heart also develop cardiogenic shock. Only half of the patients who experience cardiogenic shock will survive.
The aim of this study was to investigate differences in treatment and survival between women and men with a heart attack and cardiogenic shock.
The study included all consecutive adults admitted between 2010 and 2017 to two highly specialised centres providing cardiogenic shock care for two-thirds of the Danish population. Data on patient characteristics, treatment and 30-day mortality were extracted from medical records. Long-term mortality data were obtained from the Danish National Patient Registry.
A total of 1,716 heart attack patients with cardiogenic shock were enrolled in the study, of which 438 (26 per cent) were women. The average age of women was 71 years compared with 66 years for men. Patient characteristics were similar between sexes except for hypertension and chronic obstructive pulmonary disease which were more common among women. Women were significantly more likely than men to be initially admitted to a local hospital (41 per cent women versus 30 per cent men), while significantly more men presented with out-of-hospital cardiac arrest (25 per cent women versus 48 per cent men).
When shock occurred, women and men had comparable clinical parameters such as blood pressure, heart rate, plasma lactate (a marker of oxygen levels in the organs) and left ventricular ejection fraction (heart pump function).
Regarding treatments, significantly lower proportions of women received mechanical circulatory support (19 per cent women versus 26 per cent men), minimally invasive or surgical procedures to restore blood flow to blocked arteries (83 per cent women versus 88 per cent men), and mechanical ventilation (67 per cent women versus 82 per cent men). Women were significantly less likely than men to survive in the short and long term. At 30 days after the heart event, just 38 per cent of women were alive compared with 50 per cent of men. At 8.5 years, 27 per cent of women were alive compared with 39 per cent of men.
The researchers performed multivariate analysis to examine whether sex was independently associated with each therapy and with mortality. The analysis was adjusted for age and out-of-hospital cardiac arrest at presentation as both factors affect the outcome in heart attack patients with cardiogenic shock and are known to differ between women and men with the condition. The analysis revealed that female sex was independently associated with lower use of mechanical circulatory support and with worse short- and long-term survival.
Holle said, "There is increasing evidence that women with acute heart problems are more likely than men to have non-specific symptoms such as shortness of breath, nausea, vomiting, coughing, fatigue, and pain in the back, jaw or neck. This might be one reason why more women than men in our study were initially admitted to a local, rather than specialist, hospital. Increased recognition that women may have symptoms other than chest pain could minimise delays in diagnosis and treatment and potentially improve prognosis."
Holle concluded, "Treatment guidelines are based on studies which primarily enrolled men. Further research is needed to determine whether women and men with cardiogenic shock might benefit from different interventions."