Top

Published in:

Open Access 14-02-2024 | Cardiogenic Shock | Original Paper

Sex-related differences in patients presenting with heart failure–related cardiogenic shock

Authors: Jonas Sundermeyer, Caroline Kellner, Benedikt N. Beer, Lisa Besch, Angela Dettling, Letizia Fausta Bertoldi, Stefan Blankenberg, Jeroen Dauw, Zouhir Dindane, Dennis Eckner, Ingo Eitel, Tobias Graf, Patrick Horn, Joanna Jozwiak-Nozdrzykowska, Paulus Kirchhof, Stefan Kluge, Axel Linke, Ulf Landmesser, Peter Luedike, Enzo Lüsebrink, Nicolas Majunke, Norman Mangner, Octavian Maniuc, Sven Möbius-Winkler, Peter Nordbeck, Martin Orban, Federico Pappalardo, Matthias Pauschinger, Michal Pazdernik, Alastair Proudfoot, Matthew Kelham, Tienush Rassaf, Clemens Scherer, Paul Christian Schulze, Robert H. G. Schwinger, Carsten Skurk, Marek Sramko, Guido Tavazzi, Holger Thiele, Luca Villanova, Nuccia Morici, Ephraim B. Winzer, Dirk Westermann, Benedikt Schrage

Published in: Clinical Research in Cardiology | Issue 4/2024

Abstract

Background

Heart failure–related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS.

Methods

In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS.

Results

N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75–1.19).

Conclusions

In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS.

Graphical abstract

Sex-related differences in clinical characteristics, shock severity, and mortality in patients with heart failure–related cardiogenic shock. Summary for the main study findings. AMI, acute myocardial infarction; CI, confidence interval; HF-CS, heart failure–related cardiogenic shock; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; SCAI, Society for Cardiovascular Angiography & Interventions.

McDonagh TA, Metra M, Adamo M et al (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 42(36):3599–3726. https://doi.org/10.1093/EURHEARTJ/EHAB368CrossRefPubMed

Baran DA, Grines CL, Bailey S et al (2019) SCAI clinical expert consensus statement on the classification of cardiogenic shock: this document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Societ. Catheter Cardiovasc Interv 94(1):29–37. https://doi.org/10.1002/ccd.28329CrossRefPubMed

Naidu SS, Baran DA, Jentzer JC et al (2022) SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies: this statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association. J Am Coll Cardiol 79(9):933–946. https://doi.org/10.1016/j.jacc.2022.01.018CrossRefPubMed

Schrage B, Becher PM, Goßling A et al (2021) Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Hear Fail 8(2):1295–1303. https://doi.org/10.1002/ehf2.13202CrossRef

Berg DD, Bohula EA, van Diepen S, Katz JN, Alviar CL, Baird-Zars VM, Barnett CF, Barsness GW, Burke JA, Cremer PC, Cruz J, Daniels LB, DeFilippis AP, Haleem A, Hollenberg SM, Horowitz JM, Keller N, Kontos MC, Lawler PR, Menon V, ... Morrow DA (2019) Epidemiology of shock in contemporary cardiac intensive care units. Circ Cardiovasc Qual Outcomes 12(3):e005618. https://doi.org/10.1161/CIRCOUTCOMES.119.005618

Shah M, Patnaik S, Patel B et al (2017) Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol 107(4):287–303. https://doi.org/10.1007/S00392-017-1182-2CrossRefPubMed

Thiele H, Ohman EM, De Waha-Thiele S, Zeymer U, Desch S (2019) Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J 40(32):2671–2683. https://doi.org/10.1093/eurheartj/ehz363CrossRefPubMed

Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, Bianco C, Balla S, Patel B (2021) Fifteen-year trends in incidence of cardiogenic shock hospitalization and in-hospital mortality in the United States. J Am Heart Assoc 10(15):e021061. https://doi.org/10.1161/JAHA.121.021061

Hochman JS, Sleeper LA, Webb JG et al (2006) Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. J Am Med Assoc 295(21):2511–2515. https://doi.org/10.1001/jama.295.21.2511CrossRef

10.

Thiele H, Akin I, Sandri M et al (2017) PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 377(25):2419–2432. https://doi.org/10.1056/nejmoa1710261CrossRefPubMed

11.

Narang NM, Blumer VM, Jumean MFM et al (2023) Management of heart failure–related cardiogenic shock: practical guidance for clinicians. Heart Fail. https://doi.org/10.1016/J.JCHF.2023.04.010CrossRef

12.

Sinha SS, Rosner CM, Tehrani BN, Maini A, Truesdell AG, Lee SB, Bagchi P, Cameron J, Damluji AA, Desai M, Desai SS, Epps KC, deFilippi C, Flanagan MC, Genovese L, Moukhachen H, Park JJ, Psotka MA, Raja A, Shah P, ... Batchelor WB (2022) Cardiogenic shock from heart failure versus acute myocardial infarction: clinical characteristics, hospital course, and 1-year outcomes. Circulation. Heart Failure 15(6):e009279. https://doi.org/10.1161/CIRCHEARTFAILURE.121.009279

13.

Lüsebrink E, Binzenhöfer L, Kellnar A et al (2023) Venting during venoarterial extracorporeal membrane oxygenation. Clin Res Cardiol 112(4):464–505. https://doi.org/10.1007/S00392-022-02069-0/FIGURES/1CrossRefPubMed

14.

Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, Grines CL, Diercks DB, Hall S, Kapur NK, Kent W, Rao SV, Samsky MD, Thiele H, Truesdell AG, Henry TD (2022) SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies: this statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 79(9):933–946. https://doi.org/10.1016/j.jacc.2022.01.018CrossRefPubMed

15.

Jentzer JC, van Diepen S, Barsness GW, Henry TD, Menon V, Rihal CS, Naidu SS, Baran DA (2019) Cardiogenic shock classification to predict mortality in the cardiac intensive care unit. J Am Coll Cardiol 74(17):2117–2128. https://doi.org/10.1016/j.jacc.2019.07.077CrossRefPubMed

16.

Vallabhajosyula S, Ya’qoub L, Singh M et al (2020) Sex disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction in the young. Circ Hear Fail 13(10):E007154. https://doi.org/10.1161/CIRCHEARTFAILURE.120.007154CrossRef

17.

Elgendy IY, Wegermann ZK, Li S et al (2022) Sex differences in management and outcomes of acute myocardial infarction patients presenting with cardiogenic shock. JACC Cardiovasc Interv 15(6):642–652. https://doi.org/10.1016/j.jcin.2021.12.033CrossRefPubMed

18.

Yan I, Schrage B, Weimann J et al (2021) Sex differences in patients with cardiogenic shock. ESC Hear Fail 8(3):1775–1783. https://doi.org/10.1002/ehf2.13303CrossRef

19.

Ya’qoub L, Lemor A, Dabbagh M et al (2021) Racial, ethnic, and sex disparities in patients with STEMI and cardiogenic shock. JACC Cardiovasc Interv 14(6):653–660. https://doi.org/10.1016/j.jcin.2021.01.003CrossRefPubMed

20.

Wayangankar SA, Bangalore S, McCoy LA et al (2016) Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: a report from the CathPCI Registry. JACC Cardiovasc Interv 9(4):341–351. https://doi.org/10.1016/j.jcin.2015.10.039CrossRefPubMed

21.

Schrage B, Sundermeyer J, Beer BN et al (2023) Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Eur J Heart Fail 25(4):562–572. https://doi.org/10.1002/ejhf.2796CrossRefPubMed

22.

Sundermeyer J, Kellner C, Beer BN et al (2023) Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock. Eur J Heart Fail. https://doi.org/10.1002/ejhf.3082CrossRefPubMed

23.

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, ... Schrage B (2023) Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Clinical Research in Cardiology : Official Journal of the German Cardiac Society. Advance online publication. https://doi.org/10.1007/s00392-023-02332-y

24.

van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG, American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline (2017) Contemporary management of cardiogenic shock: a scientific statement from the american heart association. Circulation 136(16):e232–e268. https://doi.org/10.1161/CIR.0000000000000525

25.

Thayer KL, Zweck E, Ayouty M, Garan AR, Hernandez-Montfort J, Mahr C, Morine KJ, Newman S, Jorde L, Haywood JL, Harwani NM, Esposito ML, Davila CD, Wencker D, Sinha SS, Vorovich E, Abraham J, O’Neill W, Udelson J, Burkhoff D, ... Kapur NK (2020) Invasive hemodynamic assessment and classification of in-hospital mortality risk among patients with cardiogenic shock. Circ Heart Fail 13(9):e007099. https://doi.org/10.1161/CIRCHEARTFAILURE.120.007099

26.

Schrage B, Dabboura S, Yan I et al (2020) Application of the SCAI classification in a cohort of patients with cardiogenic shock. Catheter Cardiovasc Interv 96(3):E213–E219. https://doi.org/10.1002/ccd.28707CrossRefPubMed

27.

Tromp J, Ezekowitz JA, Ouwerkerk W et al (2023) Global variations according to sex in patients hospitalized for heart failure in the REPORT-HF registry. JACC Hear Fail 11(9):1262–1271. https://doi.org/10.1016/j.jchf.2023.06.028CrossRef

28.

Fengler K, Fuernau G, Desch S et al (2015) Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol 104(1):71–78. https://doi.org/10.1007/S00392-014-0767-2/METRICSCrossRefPubMed

29.

Abdel-Qadir HM, Ivanov J, Austin PC, Tu JV, Džavík V (2013) Sex differences in the management and outcomes of Ontario patients with cardiogenic shock complicating acute myocardial infarction. Can J Cardiol 29(6):691–696. https://doi.org/10.1016/J.CJCA.2012.09.020CrossRefPubMed

30.

Sundermeyer J, Dabboura S, Weimann J et al (2023) Short-term lactate kinetics in patients with cardiogenic shock. JACC Hear Fail 11(4):481–483. https://doi.org/10.1016/j.jchf.2023.01.013CrossRef

31.

Dettling A, Weimann J, Sundermeyer J, Beer BN, Besch L, Becher PM, Brunner FJ, Kluge S, Kirchhof P, Blankenberg S, Westermann D, Schrage B (2024) Association of systemic inflammation with shock severity, 30-day mortality, and therapy response in patients with cardiogenic shock. Clinical Research in Cardiology : Official Journal of the German Cardiac Society 113(2):324–335. https://doi.org/10.1007/s00392-023-02336-8CrossRefPubMed

32.

Basir MB, Lemor A, Gorgis S et al (2022) Vasopressors independently associated with mortality in acute myocardial infarction and cardiogenic shock. Catheter Cardiovasc Interv 99(3):650–657. https://doi.org/10.1002/ccd.29895CrossRefPubMed

33.

De Backer D, Biston P, Devriendt J et al (2010) Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 362(9):779–789. https://doi.org/10.1056/nejmoa0907118CrossRefPubMed

34.

Levy B, Buzon J, Kimmoun A (2019) Inotropes and vasopressors use in cardiogenic shock: when, which and how much? Curr Opin Crit Care 25(4):384–390. https://doi.org/10.1097/MCC.0000000000000632CrossRefPubMed

35.

Udesen NJ, Møller JE, Lindholm MG et al (2019) Rationale and design of DanGer shock: Danish-German cardiogenic shock trial. Am Heart J 214:60–68. https://doi.org/10.1016/j.ahj.2019.04.019CrossRefPubMed

36.

Banning AS, Adriaenssens T, Berry C et al (2021) Veno-arterial extracorporeal membrane oxygenation (ECMO) in patients with cardiogenic shock: rationale and design of the randomised, multicentre, open-label EURO SHOCK trial. EuroIntervention 16(15):E1227–E1236. https://doi.org/10.4244/EIJ-D-20-01076CrossRefPubMedPubMedCentral

37.

Thiele H, Freund A, Gimenez MR et al (2021) Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - design and rationale of the ECLS-SHOCK trial. Am Heart J 234:1–11. https://doi.org/10.1016/j.ahj.2021.01.002CrossRefPubMed

38.

Combes A, Price S, Slutsky AS, Brodie D (2020) Temporary circulatory support for cardiogenic shock. Lancet 396(10245):199–212. https://doi.org/10.1016/S0140-6736(20)31047-3/ATTACHMENT/1BE0397E-BED1-45BB-99D8-F72E5739EA19/MMC1.PDFCrossRefPubMed

39.

Dhruva SS, Ross JS, Mortazavi BJ et al (2020) Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock. JAMA - J Am Med Assoc 323(8):734–745. https://doi.org/10.1001/jama.2020.0254CrossRef

40.

Burns S, Constantin N, Robles P (2018) Understanding the long-term sequelae of ECMO survivors. Intensive Care Med 44(7):1144–1147. https://doi.org/10.1007/s00134-017-4714-3CrossRefPubMed

41.

Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S, Colson P, Cudemus Deseda G, Dabboura S, Eckner D, Eden M, Eitel I, Frank D, Frey N, Funamoto M, Goßling A, Graf T, Hagl C, Kirchhof P, Kupka D, ... Westermann D (2020) Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation 142(22):2095–2106. https://doi.org/10.1161/CIRCULATIONAHA.120.048792

42.

Schrage B, Westermann D (2019) Mechanical circulatory support devices in cardiogenic shock and acute heart failure: current evidence. Curr Opin Crit Care 25(4):391–396. https://doi.org/10.1097/MCC.0000000000000629CrossRefPubMed

43.

Vallabhajosyula S, Vallabhajosyula S, Dunlay SM et al (2020) Sex and gender disparities in the management and outcomes of acute myocardial infarction–cardiogenic shock in older adults. Mayo Clin Proc 95(9):1916–1927. https://doi.org/10.1016/J.MAYOCP.2020.01.043CrossRefPubMed

44.

Wong SC, Sleeper LA, Monrad ES et al (2001) Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. J Am Coll Cardiol 38(5):1395–1401. https://doi.org/10.1016/S0735-1097(01)01581-9CrossRefPubMed

45.

Taleb I, Koliopoulou AG, Tandar A et al (2019) Shock team approach in refractory cardiogenic shock requiring short-term mechanical circulatory support: a proof of concept. Circulation 140(1):98–100. https://doi.org/10.1161/CIRCULATIONAHA.119.040654CrossRefPubMedPubMedCentral

46.

Tehrani BN, Truesdell AG, Sherwood MW et al (2019) Standardized team-based care for cardiogenic shock. J Am Coll Cardiol 73(13):1659–1669. https://doi.org/10.1016/j.jacc.2018.12.084CrossRefPubMed

Title: Sex-related differences in patients presenting with heart failure–related cardiogenic shock
Authors: Jonas Sundermeyer
Caroline Kellner
Benedikt N. Beer
Lisa Besch
Angela Dettling
Letizia Fausta Bertoldi
Stefan Blankenberg
Jeroen Dauw
Zouhir Dindane
Dennis Eckner
Ingo Eitel
Tobias Graf
Patrick Horn
Joanna Jozwiak-Nozdrzykowska
Paulus Kirchhof
Stefan Kluge
Axel Linke
Ulf Landmesser
Peter Luedike
Enzo Lüsebrink
Nicolas Majunke
Norman Mangner
Octavian Maniuc
Sven Möbius-Winkler
Peter Nordbeck
Martin Orban
Federico Pappalardo
Matthias Pauschinger
Michal Pazdernik
Alastair Proudfoot
Matthew Kelham
Tienush Rassaf
Clemens Scherer
Paul Christian Schulze
Robert H. G. Schwinger
Carsten Skurk
Marek Sramko
Guido Tavazzi
Holger Thiele
Luca Villanova
Nuccia Morici
Ephraim B. Winzer
Dirk Westermann
Benedikt Schrage
Publication date: 14-02-2024
Publisher: Springer Berlin Heidelberg
Keywords: Cardiogenic Shock
Cardiogenic Shock
Heart Failure
Cardiopulmonary Resuscitation
ECMO
ECMO
Published in: Clinical Research in Cardiology / Issue 4/2024
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-024-02392-8

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sex-related differences in patients presenting with heart failure–related cardiogenic shock

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 4/2024

GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes

Effects of levosimendan on the outcome of veno-arterial extracorporeal membrane oxygenation: a systematic review and meta-analysis

A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiac arrest: the FACTOR study

Hemodynamic effects of the combined support with VAV-ECMO, Impella CP, and Impella RP

Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page