Abstract
Introduction: Although sex-specific differences in treatment and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) have been described, little is known about sex-specific differences in acute decompensated heart failure-related CS (ADHF-CS). Methods: The CCCTN is an investigator-initiated multicenter network of cardiac intensive care units (CICUs) in North America. Consecutive admissions (n=8240) to the CICU during annual snapshots (mostly 2 months) were submitted to the coordinating center (TIMI Study Group, Boston, MA). Patients were stratified by sex and type of CS. Adjustments were made for age and SOFA score. Results: Between 2017 and 2019, 1487 admissions were for CS of which 879 (33% women) were for ADHF-CS. In this cohort, age (median 62 y), race, and BMI (median 28 kg/m 2 ) did not differ by sex. Women and men also had similar SOFA and IABP-SHOCK II scores. Women were less likely to have CKD (28% vs 42%, p=<0.001) and CAD (28% vs 45%, p<0.001) but were significantly more likely to have underlying pulmonary disease (23% vs 15%, p<0.01). Although women and men had a similar burden of pre-existing HF (72% vs 75%, p=0.35), women were more likely to have HF with preserved ejection fraction (19% vs. 5%, p<0.001). Women had shorter CICU stays (4.0 vs 5.5 days, p<0.001), and numerically, though not significantly, lower use of pulmonary artery catheters (48% vs 53%, p=0.13) and mechanical circulatory support (28% vs 34%, p=0.11). In-hospital mortality in women with ADHF-CS was significantly higher than in men (39% vs 26%, p<0.001, adj-OR 2.05 (95% CI 1.47-2.86; p<0.001)). In contrast, in-hospital mortality for AMICS did not differ by sex (38% vs 40%, p=0.69). Conclusions: Compared to men, women admitted to the CICU with ADHF-CS had higher mortality despite similar indices of illness severity. The reason(s) behind this difference merit further study.
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