Gender impact on survival in an unselected population admitted to a modern intensive cardiac care unit

The attention about sex disparities in Cardiology has grown in the last few years, however, to date, few data are available about potential gender-related disparities in an unselected population admitted to a modern intensive cardiac care unit (ICCU).

Assessment of potential gender-related differences and their relationships with prognosis among patients admitted to a contemporary ICCU of a tertiary cardiac referral center.

All consecutive admissions, from 01/01/2019 to 31/12/2022, were retrospectively reviewed from an internal database of a tertiary cardiac center in our city.

Unadjusted and covariate-adjusted Logistic and Cox regression models were used to evaluate the association between gender and, respectively, 30-days and long term mortality. Adjustments were performed for covariates significantly associated with outcome in the univariate analysis. In order to estimate the survival rates during the follow-up, a Kaplan Meyer analysis was carried out and differences between male and female were assessed using the log-rank test. To further reduce the bias related to the difference in baseline characteristics between women and men, both short and long term mortality were also investigated in a propensity score-matched cohort. All statistical analyses were performed using SPSS software version 25.0 and R version 4.0.5. A p-value of less than 0.05 was considered significant.

3517 patients were identified. The median age was 71 (60-80). 1231 (35%) of these patients were female. 373 (10,7%) and 420 (14,2%) deaths occurred, respectively, during the first 30 days after admission, and during long term follow-up (median follow-up time: 14 months; IQR: 10-20). Women showed higher comorbidity burden (Charlson comorbidity index median value (IQR) in women vs men of 5 (4-7) vs 4 (3-6), p<0,001), and were more frail in comparison to men (Clinical Frailty Scale ≥ 5 in 41,9% of women vs 21,6% of men, p<0,001). Women were mainly admitted due to cardiovascular conditions different from acute coronary syndrome (ACS in women vs men: 49,8% vs 66,9%, p<0,001), and in case of ACS admission the female gender underwent to fewer percutaneous coronary intervention (PTCA in women vs men: 64,6% vs 79%, p<0,001). The female gender resulted associated with both 30-days and long term mortality in unadjusted regression analysis (Fig. 1); however, after multivariate and propensity matched analysis, this association was no more evident (Fig. 1 and 2).