Women more likely to die from lack of critical care after a heart attack

SOPHIA ANTIPOLIS, France — Women are less likely to receive lifesaving care following a major heart attack, a new study reveals. Researchers with the European Society of Cardiology found that older men are much more likely to survive cardiogenic shock over the short and long-terms. This may be due to the type of care they receive, including more instances of mechanical circulatory support, minimally invasive surgery, and ventilation.

“The women and men in our study had similar clinical characteristics when they developed cardiogenic shock after a heart attack,” says study author Dr. Sarah Holle of Copenhagen University Hospital in a media release. “This was a retrospective study so it is difficult to know why clinicians made certain treatment decisions. But the findings indicate that greater awareness among health professionals that women have heart attacks and may develop cardiogenic shock could be a step towards equitable management and outcomes.”

What is cardiogenic shock?

The condition occurs when the heart suddenly can’t pump enough blood to supply the other organs with oxygen. A massive heart attack is typically the cause of cardiogenic shock.

Researchers say that up to 10 percent of patients suffering a large heart attack experience cardiogenic shock. However, only half of the patients who develop cardiogenic shock survive.

To see how treatment and survival rates differ between men and women, the researchers studied over 1,700 heart attack patients experiencing cardiogenic shock between 2010 and 2017. All of these patients received treatment at one of two specialized centers providing cardiogenic shock care to the Danish population.

Only 26 percent of these patients were women (438) and had an average age of 71. The remaining patients were men with an average age of 66. Study authors also note that the women were more likely to have hypertension or chronic obstructive pulmonary disease.

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A disparity in care affecting survival rates?

Results show women were much more likely to enter a local hospital than men (41% vs. 30%) after experiencing cardiac arrest. Meanwhile, for men and women developing cardiogenic shock, both genders had similar readings in terms of blood pressure, heart rate, plasma lactate (a marker of oxygen levels in the organs), and left ventricular ejection fraction (heart pump function).

Despite those similar readings, only 19 percent of women received mechanical circulatory support, compared to 26 percent of male patients. Women were less likely to undergo surgery to clear blocked arteries (83% vs 88% for men) or receive mechanical ventilation (67% vs. 82% for men).

Concerningly, women were also much more likely to die within 30 days of a major cardiac event. Just 38 percent of the female patients in the study were still alive a month after experiencing cardiogenic shock, compared to 50 percent of men. After 8.5 years, just 27 percent of the women were still alive, compared to 39 percent of men.

“There is increasing evidence that women with acute heart problems are more likely than men to have non-specific symptoms such as shortness of breath, nausea, vomiting, coughing, fatigue, and pain in the back, jaw or neck. This might be one reason why more women than men in our study were initially admitted to a local, rather than specialist, hospital. Increased recognition that women may have symptoms other than chest pain could minimize delays in diagnosis and treatment and potentially improve prognosis,” Dr. Holle concludes.

“Treatment guidelines are based on studies which primarily enrolled men. Further research is needed to determine whether women and men with cardiogenic shock might benefit from different interventions.”

The researchers presented their findings at ESC Acute CardioVascular Care 2022.