Sex Differences in Frailty-Associated Outcomes of Patients with Cardiogenic Shock

BACKGROUND: Frailty is an important determinant of outcomes in patients with cardiovascular disease; however, its impact on the management and prognosis of cardiogenic shock (CS) remains unclear. This study examined the association between frailty and in-hospital outcomes, focusing on sex-based differences in treatment and mortality. METHODS: We used the National Inpatient Sample from 2016 to 2019 to identify adult patients hospitalized with CS. Frailty was assessed using the Hospital Frailty Risk Score and categorized as low (<5), intermediate (5-15), or high risk of frailty (>15). Logistic regression was used to estimate the odds ratios (ORs) with their 95% confidence intervals (CIs). RESULTS: Among 640,595 admissions, frailty was strongly associated with increased mortality (high vs. low risk: OR 2.15, 95% CI 2.03-2.27) and major bleeding (high vs. low risk: OR 6.18, 95% CI 5.53-6.92). Women had higher in-hospital mortality than men, but only at low (OR 1.30, 95% CI 1.22-1.39) and intermediate frailty risk (OR 1.16, 95% CI 1.13-1.20). Women had lower use of pulmonary artery catheterization, intra-aortic balloon pump, and percutaneous ventricular assist device compared to men, at any level of frailty risk. The odds of major bleeding in women versus men varied according to frailty risk. Renal replacement therapy was higher in women versus men with intermediate or high risk of frailty. CONCLUSIONS: Frailty independently predicted higher mortality and lower use of mechanical circulatory support in patients with CS. Women have worse outcomes with less invasive treatment, highlighting sex disparities in CS care.