Women with heart failure-related cardiogenic shock (HF-CS) had more vascular complications and worse outcomes than men with HF-CS and more studies are needed to advance therapies, decrease complications and improve outcomes for women with CS, according to a working group report being presented at AHA 2023 and simultaneously published Nov. 6 in JACC: Heart Failure.

Van-Khue Ton, MD, PhD, et al., examined data from CS patients in the Cardiogenic Shock Working Group (CSWG), performing propensity score matching with the use of baseline characteristics and logistic regression to analyze odds of survival. The authors compared survival at discharge between women and men with CS complicating acute myocardial infarction (AMI-CS) and HF-CS to assess the impact of female sex in CS outcomes. Of the 5,083 patients, 1,522 were women (30%) with a mean age of 61.8 years. More women than men presented with de novo HF-CS (26.2% vs. 19.3%; p<0.001), whereas a similar proportion presented with AMI-CS (30% vs. 29.1%; p=0.03). Notably, there were no significant differences between women and men regarding age, race, hypertension or diabetes.

Results showed that women, compared with men, had a worse survival at discharge rate (69.9% vs. 74.4%; p=0.009) as well as a higher rate of maximum Society for Cardiac Angiography and Interventions Stage E (26% vs. 21%; p=0.04). Women were also 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).

Furthermore, the researchers found that, 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), and more vascular complications persisted in women vs. men after propensity score matching (10.4% vs. 7.4%; p=0.06).

The authors write, “We have reported one of the largest contemporary analyses of real-world registry data on the characteristics and outcomes of women vs. men with CS, with a focus on patients with AMI-CS and HF-CS.”

In an accompanying editorial comment, Sara Kalantari, MD; Chair of the Critical Care Section Leadership Council Robert O. Roswell, MD, FACC, and Jonathan Grinstein, MD, FACC, write ‘’The results of the CSWG analysis provide valuable information about gender-related inequality in care and outcomes in the management of cardiogenic shock, although the exact mechanisms driving these observed differences still need to be elucidated. Broadly speaking, barriers in the care of women with heart failure and cardiogenic shock include a reduced awareness among both patients and providers, a deficiency of sex-specific objective criteria for guiding therapy, and unfavorable t-MCS devices with higher rates of hemocompatibility-related complications in women.”