{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:03:40Z","timestamp":1768568620438,"version":"3.49.0"},"posted":{"date-parts":[[2024,10,13]]},"group-title":"Cardiovascular Medicine","reference-count":23,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T00:00:00Z","timestamp":1728777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Limited data are available on sex differences in the time to treatment of cardiogenic shock (CS) with and without acute myocardial infarction (AMI).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>For this retrospective cohort study, we used nationally representative hospital survey data from the National Inpatient Sample (years 2016-2021) to assess sex differences in interventions, time to treatment (within versus after 24 hours of admission), and in-hospital mortality for AMI-CS and non-AMI-CS, adjusting for age, race, income, insurance, comorbidities, and prior cardiac interventions.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 1,052,360 weighted CS hospitalizations (60% non-AMI-CS; 40% AMI-CS). Women with CS had significantly lower rates of all interventions. For AMI-CS, women had a higher likelihood of in-hospital mortality after: revascularization (adjusted odds ratio (aOR) 1.15 [95% CI 1.09-1.22]), mechanical circulatory support (MCS) (1.15 [1.08-1.22]), right heart catheterization (RHC) (1.10 [1.02-1.19]) (all p&lt;0.001). Similar trends were found for the non-AMI-CS group. Women with AMI-CS were less likely to receive early (within 24 hours of admission) revascularization (0.93 [0.89-0.96]), MCS (0.76 [0.73-0.80]), or RHC (0.89 [0.84-0.95]) than men; women with non-AMI-CS were less likely to receive early revascularization (0.78 [0.73-0.84]), IABP (0.85 [0.78-0.94]), pLVAD (0.88 [0.77-0.99]) or RHC (0.83 [0.79-0.88]) than men (all p&lt;0.001). For both types of CS, in-hospital mortality was not significantly different between men and women receiving early ECMO, pLVAD, or PCI.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Sex disparities in the frequency of treatment of CS persist on a national scale, with women being more likely to die following treatment and less likely to receive early treatment. However, when comparing patients who received early treatment, in-hospital mortality does not differ significantly when men and women are treated equally within 24 hours of admission. Early intervention if clinically indicated could mitigate sex-based differences in CS outcomes and should be made a priority in the management of CS.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Clinical Perspective<\/jats:title>\n                  <jats:p>What is new?<\/jats:p>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>Women have increased in-hospital mortality with cardiogenic shock and have lower odds of early intervention (within 24 hours of admission) compared to men.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>When men and women with cardiogenic shock are treated equally in terms of early intervention within 24 hours of admission, sex differences in in-hospital mortality disappear.<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                  <jats:p>What are the clinical implications?<\/jats:p>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>Sex-based disparities are present in the utilization of treatment and time to intervention for patients with cardiogenic shock.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Early recognition and intervention for cardiogenic shock among women should be considered to improve clinical outcomes.<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.1101\/2024.10.11.24315358","type":"posted-content","created":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T13:40:27Z","timestamp":1728826827000},"source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in Management, Time to Intervention, and In-Hospital Mortality of Acute Myocardial Infarction and Non-Myocardial Infarction Related Cardiogenic Shock"],"prefix":"10.64898","author":[{"given":"Anushka","family":"Desai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan","family":"Rani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6680-0404","authenticated-orcid":false,"given":"Anum","family":"Minhas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2024101507250470000_2024.10.11.24315358v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000002433"},{"key":"2024101507250470000_2024.10.11.24315358v1.2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1750"},{"key":"2024101507250470000_2024.10.11.24315358v1.3","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14510"},{"key":"2024101507250470000_2024.10.11.24315358v1.4","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1922"},{"key":"2024101507250470000_2024.10.11.24315358v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jscai.2023.101212"},{"key":"2024101507250470000_2024.10.11.24315358v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2024.102777"},{"key":"2024101507250470000_2024.10.11.24315358v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2024.07.017"},{"key":"2024101507250470000_2024.10.11.24315358v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2021.12.033"},{"key":"2024101507250470000_2024.10.11.24315358v1.9","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14931"},{"key":"2024101507250470000_2024.10.11.24315358v1.10","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-023-00676-1"},{"key":"2024101507250470000_2024.10.11.24315358v1.11","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-04973-5"},{"issue":"15","key":"2024101507250470000_2024.10.11.24315358v1.12","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1056\/NEJMoa2312572","article-title":"Microaxial flow pump or standard care in infarct-related cardiogenic shock","volume":"390","year":"2024","journal-title":"N Engl J Med"},{"key":"2024101507250470000_2024.10.11.24315358v1.13","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13303"},{"key":"2024101507250470000_2024.10.11.24315358v1.14","unstructured":"HCUP National Readmission Database (NRD). 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