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.

Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Milan Italy

Center for Population Health Innovation University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

Department for Internal Medicine and Cardiology Heart Centre Dresden University Hospital Dresden Germany

Department of Cardiology and Angiology University Heart Center Freiburg Bad Krozingen Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center University Hospital Essen Essen Germany

Department of Cardiology Angiology and Intensive Care Medicine DHZC Berlin Campus Benjamin Franklin Berlin Germany

Department of Cardiology AZ Sint Lucas Ghent Belgium

Department of Cardiology IKEM Prague Czech Republic

Department of Cardiology Paracelsus Medical University Nürnberg Nuremberg Germany

Department of Cardiology University Heart and Vascular Center Hamburg Martinistr 52 20251 Hamburg Germany

Department of Clinical Surgical Diagnostic and Paediatric Sciences Anesthesia and Intensive Care University of Pavia Italy Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy

Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Internal Medicine 1 University Hospital Jena Jena Germany

Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine and Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Science Leipzig Germany

Department of Medicine 1 University Hospital LMU Munich Munich Germany

Department of Perioperative Medicine St Bartholomew's Hospital London UK

Dept Cardiothoracic and Vascular Anesthesia and Intensive Care AO SS Antonio E Biagio E Cesare Arrigo Alessandria Italy

Division of Cardiology Pulmonology and Vascular Medicine Medical Faculty University Duesseldorf Düsseldorf Germany

German Center for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Hamburg Germany

IRCCS Fondazione Don Gnocchi ONLUS Santa Maria Nascente Milan Italy

Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany

Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio Center ASST Grande Ospedale Metropolitano Niguarda Milan Italy

University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany

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