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Takla A, Mostafa MR, Eid MM, Abuelazm M, Hassan AR, Katamesh B, Mahmoud A, Abusnina W, Belal M, Ziada AR, Paul TK, Goldsweig AM. Sex difference in outcomes and management of cardiogenic shock: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102777. [PMID: 39103132 DOI: 10.1016/j.cpcardiol.2024.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is associated with significant morbidity and mortality. Sex differences in the outcomes and management of cardiogenic shock are not well established. The primary objective of this study is to investigate the differences inik cardiogenic shock outcomes between males and females. METHODS A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Studies were searched via the MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to December 2022. RESULTS The analysis included 24 studies comprising 1,567,660 patients. Compared to females, males with CS had a significantly lower risk of in-hospital all-cause mortality (risk ratio [RR] 0.88, 95 % confidence interval [CI] 0.85-0.90, p < 0.001) and 1-year mortality (RR 0.90, 95 % CI 0.89-0.92, p < 0.001). Males were more likely to undergo percutaneous coronary intervention (RR 1.21, 95 % CI 1.13-1.31, p < 0.0001) and intra-aortic balloon pump placement (RR 1.21, 95 % CI 1.11-1.32, p < 0.0001), with no significant sex differences in the use of extracorporeal membrane oxygenation or Impella. During the index hospitalization, males were at higher risk of arrhythmias (RR 1.18, 95 % CI 1.05-1.34, p = 0.003) and less likely to develop acute kidney injury (RR 0.86, 95 % CI 0.79-0.94, p < 0.001). CONCLUSION Men have a lower all-cause mortality risk in cardiogenic shock. Addressing disparities in management is crucial for improving CS outcomes, especially for women.
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Affiliation(s)
- Andrew Takla
- Rochester Regional Health/Unity Hospital, Rochester, New York, USA.
| | | | | | | | | | | | | | - Waiel Abusnina
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Mohamed Belal
- Alexandria University, School of Medicine, Alexandria, Egypt
| | | | - Timir K Paul
- University of Tennessee Health Sciences Center/ Ascension St. Thomas Hospital, Nashville, TN, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Manzo-Silberman S, Martin AC, Boissier F, Hauw-Berlemont C, Aissaoui N, Lamblin N, Roubille F, Bonnefoy E, Bonello L, Elbaz M, Schurtz G, Morel O, Leurent G, Levy B, Jouve B, Harbaoui B, Vanzetto G, Combaret N, Lattucca B, Champion S, Lim P, Bruel C, Schneider F, Seronde MF, Bataille V, Gerbaud E, Puymirat E, Delmas C. Sex disparities in cardiogenic shock: Insights from the FRENSHOCK registry. J Crit Care 2024; 82:154785. [PMID: 38493531 DOI: 10.1016/j.jcrc.2024.154785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial. OBJECTIVES The aim was to analyze the impact of sex on aetiology, management and prognosis of CS. METHODS The FRENSHOCK registry included all CS admitted in 49 French Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) between April and October 2016. RESULTS Among the 772 CS patients included, 220 were women (28.5%). Women were older, less smokers, with less history of ischemic cardiac disease (20.5% vs 33.6%) than men. At admission, women presented less cardiac arrest (5.5 vs 12.2%), less mottling (32.5 vs 41.4%) and higher LVEF (30 ± 14 vs 25 ± 13%). Women were more often managed via emergency department while men were directly admitted at ICU/ICCU. Ischemia was the most frequent trigger irrespective of sex (36.4% in women vs 38.2%) but women had less coronary angiogram and PCI (45.9% vs 54% and 24.1 vs 31.3%, respectively). We found no major difference in medication and organ support. Thirty-day mortality (26.4 vs 26.5%), transplant or permanent assist device were similar in both sexes. CONCLUSION Despite some more favorable parameters in initial presentation and no significant difference in medication and support, women shared similar poor prognosis than men. Further analysis is required to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities. NCT02703038.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France; Université de Paris, INSERM, Innovative Therapies in Haemostasis, 75006 Paris, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France; Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Bordeaux U1045, France; Université de Paris, 75006 Paris, France.
| | - Anne-Céline Martin
- Cardiology Department, AP HP, European Hospital Georges Pompidou, 75015, France
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, INSERM CIC 1402 (IS-ALIVE group), Université de Poitiers, Member of FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Poitiers, France
| | - Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Université Paris Cité, Paris, France
| | - Nadia Aissaoui
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre - Université de Paris, Medical School, Paris, France
| | - Nicolas Lamblin
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - François Roubille
- PhyMedExp, Cardiology Department, University of Montpellier, INSERM U1046, CNRS UMR, 9214; INI-CRT, Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France
| | - Guillaume Schurtz
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Guillaume Leurent
- Univ Rennes1, Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1009, F-35000 Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Bernard Jouve
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, Avenue des Tamaris, 13616, cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benoit Lattucca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Sébastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Cédric Bruel
- Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75674 Paris, France
| | - Francis Schneider
- Médecine intensive réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg et Unistra, Faculté de Médecine, Strasbourg, France
| | | | - Vincent Bataille
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Adimep : Association pour la Diffusion de la Médecine de Prévention, Toulouse, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Recherche Enseignement en Insuffisance cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, France.
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Smith E, Tamis-Holland JE. Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions. Curr Opin Crit Care 2024; 30:344-353. [PMID: 38841913 DOI: 10.1097/mcc.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Cardiogenic shock (CS) is a devasting complicating of acute myocardial infarction (AMI), associated with significant mortality. Prior studies have reported sex differences in the presentation, management and outcomes of patients with AMI and CS. These differences are likely due to a variety of factors influencing therapeutic decision-making and impacting survival. This review highlights the more contemporary studies exploring differences in women and men with AMI-CS, providing a critical perspective towards understanding the factors that might lead to these differences and outlining potential opportunities to reduce disparities in treatment and improve survival for women with AMI-CS. RECENT FINDINGS Recent reports demonstrate that women with AMI-CS are older than men and have more cardiovascular comorbidities. When examining an unselected population of patients with AMI-CS, women receive less aggressive treatment compared to men and have poorer outcomes. However, when examining a selected population of patients with AMI-CS treated with mechanical circulatory support (MCS) and/or admitted to centers that implement CS protocols to manage AMI-CS, these sex-based differences in outcomes are largely mitigated. SUMMARY Standardizing protocols for the diagnosis and treatment of patients with AMI-CS, with an emphasis on early revascularization and appropriate invasive therapies, can improve outcomes in women and narrow the gender gap.
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Affiliation(s)
- Emily Smith
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Fisher T, Hill N, Kalakoutas A, Lahlou A, Rathod K, Proudfoot A, Warren A. Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis. Crit Care 2024; 28:192. [PMID: 38845019 PMCID: PMC11157877 DOI: 10.1186/s13054-024-04973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic shock in women and men. To examine differences in 30-day mortality and mechanical circulatory support use by sex in patients with cardiogenic shock. MAIN BODY Cochrane Central, PubMed, MEDLINE and EMBASE were searched in April 2024. Studies were included if they were randomised controlled trials or observational studies, included adult patients with cardiogenic shock, and reported at least one of the following outcomes by sex: raw mortality, adjusted mortality (odds ratio) or use of mechanical circulatory support. Out of 4448 studies identified, 81 met inclusion criteria, pooling a total of 656,754 women and 1,018,036 men. In the unadjusted analysis for female sex and combined in-hospital and 30-day mortality, women had higher odds of mortality (Odds Ratio (OR) 1.35, 95% confidence interval (CI) 1.26-1.44, p < 0.001). Pooled unadjusted mortality was 35.9% in men and 40.8% in women (p < 0.001). When only studies reporting adjusted ORs were included, combined in-hospital/30-day mortality remained higher in women (OR 1.10, 95% CI 1.06-1.15, p < 0.001). These effects remained consistent across subgroups of acute myocardial infarction- and heart failure- related cardiogenic shock. Overall, women were less likely to receive mechanical support than men (OR = 0.67, 95% CI 0.57-0.79, p < 0.001); specifically, they were less likely to be treated with intra-aortic balloon pump (OR = 0.79, 95% CI 0.71-0.89, p < 0.001) or extracorporeal membrane oxygenation (OR = 0.84, 95% 0.71-0.99, p = 0.045). No significant difference was seen with use of percutaneous ventricular assist devices (OR = 0.82, 95% CI 0.51-1.33, p = 0.42). CONCLUSION Even when adjusted for confounders, mortality for cardiogenic shock in women is approximately 10% higher than men. This effect is seen in both acute myocardial infarction and heart failure cardiogenic shock. Women with cardiogenic shock are less likely to be treated with mechanical circulatory support than men. Clinicians should make immediate efforts to ensure the prompt diagnosis and aggressive treatment of cardiogenic shock in women.
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Affiliation(s)
- Thomas Fisher
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK
| | - Nicole Hill
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK
| | | | - Assad Lahlou
- Barts Health Library Services, W Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj Rathod
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, W Smithfield, London, EC1A 7BE, UK
| | - Alastair Proudfoot
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, W Smithfield, London, EC1A 7BE, UK
| | - Alex Warren
- Barts Health NHS Trust, W Smithfield, London, EC1A 7BE, UK.
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, W Smithfield, London, EC1A 7BE, UK.
- Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
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5
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Ton VK, Kanwar MK, Li B, Blumer V, Li S, Zweck E, Sinha SS, Farr M, Hall S, Kataria R, Guglin M, Vorovich E, Hernandez-Montfort J, Garan AR, Pahuja M, Vallabhajosyula S, Nathan S, Abraham J, Harwani NM, Hickey GW, Wencker D, Schwartzman AD, Khalife W, Mahr C, Kim JH, Bhimaraj A, Sangal P, Zhang Y, Walec KD, Zazzali P, Burkhoff D, Kapur NK. Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report. JACC. HEART FAILURE 2023; 11:1742-1753. [PMID: 37930289 DOI: 10.1016/j.jchf.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Studies reporting cardiogenic shock (CS) outcomes in women are scarce. OBJECTIVES The authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS). METHODS The authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival. RESULTS Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs 19.3%; P < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs 74.4%; P = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs 5.7%; P < 0.001), bleeding (7.1% vs 5.2%; P = 0.01), and limb ischemia (6.8% vs 4.5%; P = 0.001). More vascular complications persisted in women after PSM (10.4% women vs 7.4% men; P = 0.06). CONCLUSIONS Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications, and improve outcomes of women with CS.
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Affiliation(s)
- Van-Khue Ton
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Borui Li
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Elric Zweck
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Maryjane Farr
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | - Rachna Kataria
- Lifespan Cardiovascular Center, Brown University, Providence, Rhode Island, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Esther Vorovich
- Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois, USA
| | | | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gavin W Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju H Kim
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Paavni Sangal
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yijing Zhang
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Karol D Walec
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Peter Zazzali
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
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Oliveros E, Saldarriaga Giraldo CI, Hall J, Tinuoye E, Rodriguez MJ, Gallego C, Contreras JP. Addressing Barriers for Women with Advanced Heart Failure. Curr Cardiol Rep 2023; 25:1257-1267. [PMID: 37698818 DOI: 10.1007/s11886-023-01946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Describe disparities in diagnosis and management between men and women with advanced heart failure (HF). Our goal is to identify barriers and suggest solutions. RECENT FINDINGS Women with advanced HF are less likely to undergo diagnostic testing and procedures (i.e., revascularization, implantable cardioverter defibrillators, cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplantation). Disparities related to gender create less favorable outcomes for women with advanced HF. The issues arise from access to care, paucity of knowledge, enrollment in clinical trials, and eligibility for advanced therapies. In this review, we propose a call to action to level the playing field in order to improve survival in women with advanced HF.
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Affiliation(s)
- Estefania Oliveros
- Heart and Vascular Institute, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19444, USA.
| | | | - Jillian Hall
- Heart and Vascular Institute, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19444, USA
| | - Elizabeth Tinuoye
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | | | - Catalina Gallego
- Pontificia Bolivariana, University of Antioquia, Cardiovid Clinic, Medellin, Colombia
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7
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Nakamura M, Imamura T, Ueno H, Kinugawa K, Investigators JP. Sex-Related Differences in Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving Impella Support in Japan: From the J-PVAD Registry. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1208. [PMID: 37512020 PMCID: PMC10385926 DOI: 10.3390/medicina59071208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Sex-specific outcome in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving temporary mechanical circulatory support remains controversial. Materials and Methods: Patients with AMI-CS who received Impella support were prospectively enrolled in the Japanese registry for Percutaneous Ventricular Assist Device. Patients enrolled between January 2021 and December 2022 were considered to be eligible. Patients with out-of-hospital cardiac arrest and those without revascularization were excluded. The sex disparity in the 30-day survival after the initiation of Impella support was evaluated. Results: A total of 924 patients (median age 73 years; 21% female) were included. Female patients were older and had a smaller physiques than male patients (p < 0.05 for both). Female sex was significantly associated with a higher 30-day mortality after adjustment for four other potential confounders with a hazard ratio of 1.365 (95% confidence interval 1.026-1.816, p = 0.0324). In the female cohort, patients who received Impella prior to revascularization (N = 138) had a greater survival rate compared to those who received Impella after revascularization (68.1% versus 44.8%, p = 0.0015). Conclusions: Among the patients with AMI-CS who received Impella support and underwent revascularization, female sex was independently associated with a lower 30-day survival. For female patients, early initiation of Impella support prior to revascularization may improve their clinical outcomes.
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Affiliation(s)
- Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
| | - J-Pvad Investigators
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
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8
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Hill KL, Rustin MA, Asche MA, Bennett CE, Patel PC, Jentzer JC. Cardiogenic Shock Classification and Associated Mortality Risk. Mayo Clin Proc 2023; 98:771-783. [PMID: 37028976 DOI: 10.1016/j.mayocp.2022.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 04/09/2023]
Abstract
The Society for Cardiovascular Angiography and Interventions (SCAI) Shock Classification was developed to create standardized language describing the severity of cardiogenic shock (CS). The purposes of this review were to evaluate short-term and long-term mortality rates at each SCAI shock stage for patients with or at risk for CS, which has not been studied previously, and to propose using the SCAI Shock Classification to develop algorithms for clinical status monitoring. A detailed literature search was conducted for articles published from 2019 through 2022 in which the SCAI shock stages were used to assess the mortality risk. In total, 30 articles were reviewed. The SCAI Shock Classification at hospital admission revealed a consistent and reproducible graded association between shock severity and mortality risk. Furthermore, shock severity correlated incrementally with mortality risk even after patients were stratified for diagnosis, treatment modalities, risk modifiers, shock phenotype, and underlying cause. The SCAI Shock Classification system can be used to evaluate mortality across populations of patients with or at risk for CS including those with different causes, shock phenotypes, and comorbid conditions. We propose an algorithm that uses clinical parameters incorporating the SCAI Shock Classification into the electronic health record to continually reassess and reclassify the presence and severity of CS across time throughout hospitalization. The algorithm has the potential to alert the care team and a CS team, leading to earlier recognition and stabilization of the patient, and may facilitate the use of treatment algorithms and prevent CS deterioration, leading to improved outcomes.
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Affiliation(s)
- Katherine L Hill
- Department of Nursing, Mayo Clinic, Rochester, MN; Doctor of Nursing Program, Winona State University, Winona, MN
| | - Mark A Rustin
- Department of Nursing, Mayo Clinic, Rochester, MN; Doctor of Nursing Program, Winona State University, Winona, MN
| | | | | | - Parag C Patel
- Division of Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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9
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Schmitt A, Schupp T, Rusnak J, Ruka M, Egner-Walter S, Mashayekhi K, Tajti P, Ayoub M, Behnes M, Akin I, Weidner K. Does sex affect the risk of 30-day all-cause mortality in cardiogenic shock? Int J Cardiol 2023; 381:105-111. [PMID: 37004944 DOI: 10.1016/j.ijcard.2023.03.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Mortality rates following CS have stagnated on an unacceptably high level. Limited data regarding the prognostic value of sex in patients suffering from CS is available. Therefore, this study aims to investigate the prognostic value of sex in patients with cardiogenic shock (CS). METHODS Consecutive patients with CS of any cause were included from 2019 to 2021. Prognosis of females was compared to males regarding 30-day all-cause mortality. Further risk stratification was performed according to the presence or absence of CS related to acute myocardial infarction (AMI). Kaplan-Meier and multivariable Cox proportional regression analyses were used for statistics. RESULTS From a total of 273 CS patients (AMI-CS: 49%; non-AMI-CS: 51%), 60% were males and 40% females. The risk of 30-day all-cause mortality did not differ among males and females (56% vs. 56%; log rank p = 0.775; HR = 1.046; 95% CI 0.756-1.447; p = 0.785). Even after multivariable adjustment, sex was not associated with prognosis in CS patients (HR = 1.057; 95% CI 0.713-1.564; p = 0.784). Comparable risks of short-term mortality in both sexes were observed irrespective of the presence of AMI-related CS (64.0% vs. 64.6%; log rank p = 0.642; HR = 1.103; 95% CI 0.710-1.713; p = 0.664) and non-AMI-related CS (46.2% vs. 49.2%; log rank p = 0.696; HR = 1.099; 95% CI 0.677-1.783; p = 0.704). CONCLUSION Sex was not associated with the risk of 30-day all-cause mortality in CS patients irrespective of CS etiology. (clinicaltrials.gov identifier: NCT05575856).
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Affiliation(s)
- Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, Hungary
| | - Mohammed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, Bad Oeynhausen, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany.
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
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Lozano-Jiménez S, Iranzo-Valero R, Segovia-Cubero J, Gómez-Bueno M, Rivas-Lasarte M, Mitroi C, Escudier-Villa JM, Oteo-Dominguez JF, Vieitez-Florez JM, Villar-García S, Hernández-Pérez FJ. Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center. Front Cardiovasc Med 2022; 9:912802. [PMID: 35911539 PMCID: PMC9326060 DOI: 10.3389/fcvm.2022.912802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients. Purpose The primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex. Methods This is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC). Results Overall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44-62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group (p < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males (p = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, p > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, p = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582-0.725). The AUC was 0.636 for women (95% CI 0.491-0.780) and 0.658 for men (95% CI 0.575-0.740). Conclusions Only one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients.
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Affiliation(s)
- Sara Lozano-Jiménez
- Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
- Centre of Biomedical Research in Cardiovascular Diseases (CIBERCV), Carlos III, Madrid, Spain
| | | | | | | | | | - Cristina Mitroi
- Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
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11
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Timing of impella placement in PCI for acute myocardial infarction complicated by cardiogenic shock: An updated meta-analysis. Int J Cardiol 2022; 362:47-54. [DOI: 10.1016/j.ijcard.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
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12
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Jerónimo A, Ferrández-Escarabajal M, Ferrera C, Noriega FJ, Diz-Díaz J, Fernández-Jiménez R, McInerney A, Fernández-Ortiz A, Viana-Tejedor A. Cardiogenic Shock Clinical Presentation, Management, and In-Hospital Outcomes in Patients Admitted to the Acute Cardiac Care Unit of a Tertiary Hospital: Does Gender Play a Role? J Clin Med 2020; 9:jcm9103117. [PMID: 32992550 PMCID: PMC7601399 DOI: 10.3390/jcm9103117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiogenic shock (CS), as the most severe form of heart failure, is associated with very high mortality rates despite therapeutic advances in the last decades. Gender differences in outcomes have been widely reported regarding several cardiovascular diseases. The aim of our study was to evaluate potential gender disparities in clinical presentation, management, and in-hospital outcomes of all (n = 138) patients admitted to the Acute Cardiac Care Unit of a tertiary hospital from 2013 to 2019. Information on demographic characteristics, past medical history, haemodynamic and clinical status at admission, therapeutic management, and in-hospital outcomes was retrospectively collected. Women represented 31.88% of the cohort, were significantly older than the men and had a lower proportion of smokers, chronic obstructive pulmonary disease, and previous acute myocardial infarction (AMI). Most CSs in both groups were AMI-related. Left ventricular ejection fraction at admission was higher in women, who were less likely to receive vasopressors. No differences were observed regarding mechanical circulatory support use and in-patient outcomes, with age being the only factor associated with in-hospital mortality on multivariate analysis.
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Affiliation(s)
- Adrian Jerónimo
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Marcos Ferrández-Escarabajal
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Carlos Ferrera
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Francisco J. Noriega
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Jesús Diz-Díaz
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Rodrigo Fernández-Jiménez
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
- Centro Nacional de Investigación Cardiovascular (CNIC), 28029 Madrid, Spain
| | - Angela McInerney
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Antonio Fernández-Ortiz
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
| | - Ana Viana-Tejedor
- Acute Cardiac Care Unit, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.J.); (M.F.-E.); (C.F.); (F.J.N.); (J.D.-D.); (R.F.-J.); (A.M.); (A.F.-O.)
- Correspondence: ; Tel.: +34-91-330-33-000 (ext. 20655)
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