In younger patients with acute MI, cardiogenic shock, women more often die in hospital
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Women hospitalized with acute MI and cardiogenic shock may undergo less aggressive treatment and have higher rates of in-hospital mortality compared with men, researchers reported.
According to findings published in Circulation: Heart Failure, hospitalization costs were less for women than men, but the sexes had similar lengths of stay, which was attributed to the prevalence of less aggressive treatment among women.
“It is very concerning that the young, productive women of our society face these health care disparities,” Saraschandra Vallabhajosyula, MD, MSc, clinical fellow in interventional cardiology at Emory University School of Medicine, said in a press release.
“As clinicians, we need to understand the likely multiple motivators and factors, both individual and system-based, that might lead to unconscious bias,” Vallabhajosyula said in the release. “Our emphasis should be on providing high-quality and equitable care for every patient independent of their sex.”
For this analysis, researchers analyzed 90,648 patients from the National Inpatient Sample aged 18 to 55 years who were hospitalized with acute MI and cardiogenic shock to determine whether sex impacted outcomes in hospitalization for acute MI with cardiogenic shock. The primary outcomes included in-hospital mortality, use of cardiac interventions, hospitalization cost and length of stay.
Prevalence of acute MI admission complicated by cardiogenic shock was similar among men and women (3.6% vs. 3.5%; P < .001). However, more men overall presented with cardiogenic shock (67,004 vs. 23,644; P < .001) compared with women.
Compared with men, women with acute MI and cardiogenic shock experienced less STEMI with cardiogenic shock at presentation (73% vs. 78.7%), less noncardiac organ failure and lower incidence of cardiac arrest (34.3% vs. 35.7%; P for all < .001).
Fewer interventions, greater mortality
Fewer women hospitalized with acute MI and cardiogenic shock received coronary angiography (78.3% vs. 81.4%), early coronary angiography (49.2% vs. 54.1%), PCI (59.2% vs. 64%), CABG (18.3% vs. 20.1%) and mechanical circulatory support (50.3% vs. 59.2%; P for all < .001) compared with men.
Investigators found that among younger acute MI, cardiogenic shock admissions, female sex was an independently associated with an 11% increased risk for in-hospital mortality (adjusted OR = 1.11; 95% CI, 1.07-1.16).
According to the study, women had lower hospitalization costs (mean cost, $156,372 vs. $167,669; P < .001) compared with men despite slightly longer lengths of stay (women, 10.6 days; men, 10.3 days; P = .001).
“Fewer treatments prescribed for women led to lower use of resources, therefore, women had lower hospitalization costs. Additional studies are needed to help us more fully understand and make the changes necessary to improve treatment and eliminate disparities in care,” Vallabhajosyula said in the release.
Underrecognition and undertreatment
“[Vallabhajosyula and colleagues’] work generates the hypothesis that underrecognition and undertreatment of younger women with acute MI and cardiogenic shock may have mortality consequences, given that mortality for women was particularly high among those who did not receive mechanical circulatory support. This strengthens the call for detailed registries to further investigate the phenomenon of cardiogenic shock in young women and highlights the importance of conscious efforts to ensure that mechanical circulatory support devices meet the needs of female patients,” Amanda R. Vest , MBBS, MPH, medical director of the cardiac transplantation program and assistant professor of medicine at Tufts Medical Center, and Leslie Cho, MD, director of the Women’s Cardiovascular Center at Cleveland Clinic, wrote in a related editorial. “The evolution of the Cardiogenic Shock Team and a host of clinical innovations in mechanical circulatory support devices over the past decade represent major advances within cardiology, but we have a responsibility to achieve parity in this progress. Ensuring that young women, especially socially or economically disadvantaged women, are not left behind during these critical care advances is a challenge that must be embraced throughout the acute MI and cardiogenic shock clinical and research community.”
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