Dissecting Disparities in Cardiogenic Shock Treatment & Survival

Dissecting Disparities in Cardiogenic Shock Treatment & Survival

Cardiogenic shock is a serious condition that occurs when the heart can no longer pump enough blood to meet the body's needs. It often occurs after a heart attack and can lead to death if not treated.

In fact, approximately 10 percent of patients with heart attacks that affect a large area of the heart go on to develop cardiogenic shock, and only half of those patients will survive.

But is treatment and survival equal among men and women who experience cardiogenic shock after a heart attack? That’s the exact question a recent study sought to answer, and now, the results—which were presented at the ESC Acute Cardiovascular Care 2022 scientific congress—are in.

How Was the Study Designed?

Led by Dr. Sarah Holle from Rigshospitalet, which is the Copenhagen University Hospital in Denmark, researchers conducted a retrospective study examining data on patient characteristics, treatment, 30-day mortality, and long-term mortality of 1,716 heart attack patients. These patients were admitted to one of two specialized centers in Denmark that provide cardiogenic shock care.

Of the 1,116 patients in the study, 438 were women whose average age was 71 years compared to 66 years for men. Hypertension and chronic obstructive pulmonary disease were both more common in female participants, but all other patient characteristics were similar between men and women.

Additionally, when cardiogenic shock occurred, clinical parameters like blood pressure, heart rate, heart pump function, and plasma lactate were comparable among men and women.

So if all of the above factors and characteristics were similar in both genders, the question then becomes…

Why Are Women More Likely to Die After a Heart Emergency?

Based on the study’s findings, women were significantly more likely than men to be admitted to a local hospital initially as opposed to a specialized hospital. This is especially concerning since researchers found that 48 percent of men presented with out-of-hospital cardiac arrest.

Researchers believe more women might have initially been admitted to a local hospital due to the fact that they tend to have non-specific symptoms, such as shortness of breath, nausea, vomiting, coughing, and fatigue, while men tend to experience the traditional chest pain symptom.

Another potential reason behind the disparity in survival rates among men and women involves treatment selection, as proven by the statistics below:

• 19 percent of women received mechanical circulatory support versus 26 percent of men
• 83 percent of women received minimally invasive or surgical procedures versus 88 percent of men
• 67 percent of women received mechanical ventilation versus 82 percent of men

Only 38 percent of women were alive 30 days after the heart emergency, while 50 percent of men were alive. Similar statistics were seen at 8.5 years, as 27 percent of women were alive compared to 39 percent of men.

Where Do We Go from Here?

Though troubling, studies like the above are important because they draw attention to the disparities that continue to exist in cardiac care. And while the number of people who die from cardiogenic shock has decreased by 42 percent over the past two decades, it’s still important to raise awareness of the prevalence of cardiogenic shock and the unique symptoms women may experience to help reduce diagnostic and lifesaving treatment delays.

References:
Antipolis, Sophia. “Women More Likely to Die after Heart Emergency than Men.” European Society of Cardiology, March 19, 2022. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Women-more-likely-to-die-after-heart-emergency-than-men.