Sex Disparities in the Management, Outcomes, and Transfer of Patients Hospitalized for Cardiogenic Shock

Paulina Luna, Luke K. Kim, Ilhwan Yeo, Nupoor Narula, Diala Steitieh, Pritha Subramanyam, Maria G. Karas, Erin M. Iannacone, Yoshifumi Naka, Natalia I. Girardi, Ankur Srivastava, David T. Majure, Jaya Kanduri, Evelyn M. Horn, Jim W. Cheung, Dmitriy N. Feldman, Daniel Y. Lu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Previous studies have shown that women have worse outcomes for cardiogenic shock (CS) than men. Patients who receive care in CS “hubs” have also been shown to have improved outcomes when compared to those treated at “spokes.” This study aimed to examine the presence of sex disparities in the outcomes of CS in relation to hospital type. Methods: Hospitalizations of adults with a diagnosis of CS were identified using data from the 2016-2019 Nationwide Readmissions Database. CS “hubs” were defined as any centers receiving at least 1 interhospital transfer with CS, while those without such transfers were classified as “spokes.” Data were combined across years and multivariable logistic regression modeling was used to evaluate the association of sex with in-hospital mortality, invasive procedures, and transfer to hubs. Results: There were a total of 618,411 CS hospitalizations (62.2% men) with CS related to acute myocardial infarction comprising 15.3 to 17.3% of women hospitalizations and 17.8 to 20.3% of men hospitalizations. In-hospital mortality was lower at hubs (34.5% for direct admissions, 31.6% for transfers) than at spokes (40.3%, all P < .01). Women underwent fewer invasive procedures (right heart catheterization, percutaneous coronary intervention, mechanical circulatory support) and had higher mortality than men. Female sex was independently associated with decreased transfers to hubs (odds ratio, 0.93; 95% CI, 0.89-0.96) and increased mortality (odds ratio, 1.09; 95% CI, 1.05-1.12). Conclusions: Women with CS were less likely to be treated at a hub or transferred to a hub, had higher in-hospital mortality, and had a lower likelihood of receiving CS-related procedures than men. Further research is needed to understand sex-specific gaps in CS outcomes.

Original languageEnglish (US)
Article number101212
JournalJournal of the Society for Cardiovascular Angiography and Interventions
Volume3
Issue number3
DOIs
StatePublished - Mar 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)

Keywords

  • cardiogenic shock
  • hub
  • sex disparities
  • spoke
  • transfer

Fingerprint

Dive into the research topics of 'Sex Disparities in the Management, Outcomes, and Transfer of Patients Hospitalized for Cardiogenic Shock'. Together they form a unique fingerprint.

Cite this