SEX AND RACE/ETHNICITY DIFFERENCES ON IN-HOSPITAL OUTCOMES IN OCTOGENARIANS WITH CARDIOGENIC SHOCK

Background: Cardiogenic shock carries a high mortality rate, particularly among octogenarians. Our aim was to evaluate the clinical characteristics, management, and in-hospital outcomes among octogenarians, with a particular focus on sex and race/ethnicity differences. Methods: Retrospective cohort study using the National Inpatient Sample (NIS) including patients ≥80 years old hospitalized with cardiogenic shock from 2016 to 2019. Patients were stratified by sex and race/ethnicity (White, Black, Hispanic). Logistic regression was used to estimate odds ratios (OR) with their 95% confidence interval (CI). Results: Among 110,610 patients, in-hospital mortality was 44.6%, with significant differences by sex and race/ethnicity (P = 0.013). Mortality was highest in White females (46.0%) and Black females (46.1%), while Hispanic males had the lowest rate (43.1%). After adjustment, White females had a higher mortality risk compared to White males (OR 1.07, 95% CI 1.01-1.14, P = 0.022). Black and Hispanic patients had lower utilization of intra-aortic balloon pumps and percutaneous ventricular assist devices (P < 0.001), but experienced higher rates of major bleeding (Black males 8.0%, Black females 7.2%) and renal replacement therapy (Black males 8.4%, Black females 8.6%) (P < 0.001). Hispanic males had the highest total hospital charges (median 133,115), while Black females had the lowest (median 77,006) (P < 0.001). Conclusions: Significant sex and race/ethnicity differences exist in outcomes among octogenarians with cardiogenic shock. White females had the highest mortality, while Black and Hispanic patients had lower utilization of advanced therapies but higher complication rates. Addressing these differences is essential to improve equity in cardiovascular care.