Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

Abstract

Background: Timely management of acute myocardial infarction (AMI) and acute stroke has undergone impressive progress during the last decade. However, it is currently unknown whether both sexes have profited equally from improved strategies. We sought to analyze sex-specific temporal trends in intensive care unit (ICU) admission and mortality in younger patients presenting with AMI or stroke in Switzerland.

Methods: Retrospective analysis of temporal trends in 16,954 younger patients aged 18 to ≤ 52 years with AMI or acute stroke admitted to Swiss ICUs between 01/2008 and 12/2019.

Results: Over a period of 12 years, ICU admissions for AMI decreased more in women than in men (- 6.4% in women versus - 4.5% in men, p < 0.001), while ICU mortality for AMI significantly increased in women (OR 1.2 [1.10-1.30], p = 0.032), but remained unchanged in men (OR 0.99 [0.94-1.03], p = 0.71). In stroke patients, ICU admission rates increased between 3.6 and 4.1% per year in both sexes, while ICU mortality tended to decrease only in women (OR 0.91 [0.85-0.95, p = 0.057], but remained essentially unaltered in men (OR 0.99 [0.94-1.03], p = 0.75). Interventions aimed at restoring tissue perfusion were more often performed in men with AMI, while no sex difference was noted in neurovascular interventions.

Conclusion: Sex and gender disparities in disease management and outcomes persist in the era of modern interventional neurology and cardiology with opposite trends observed in younger stroke and AMI patients admitted to intensive care. Although our study has several limitations, our data suggest that management and selection criteria for ICU admission, particularly in younger women with AMI, should be carefully reassessed.

Keywords: Cardiovascular diseases; Critical care; Gender bias; Gender gap; Mortality trend; Sex disparities.

Fig. 1

Mortality trends over time in women and men with acute myocardial infarction admitted to intensive care units in Switzerland. Data are presented as observed deaths per 1000 patients in ICU each year (points) and modeled trends (lines)

Fig. 2

A Time trends of overall mortality, ICU mortality, and ICU admission in patients with acute myocardial infarction. B Time trends of overall mortality (no statistically significant change over time), ICU mortality (no statistically significant change over time, but tendency toward decline in women), and ICU admission in patients with ischemic stroke. Data are presented as observed numbers of patients in each year, with dotted lines representing overall patients admitted to the ICU, dashed lines showing overall deaths reported to the FSO, and continuous lines showing deaths reported in the ICU. FSO, Swiss Federal Statistical Office; ICU, intensive care unit

Fig. 3

A Time trends of disease severity estimated by SAPS II and nursing workload estimated by NEMS in ICU patients admitted with acute myocardial infarction. B Time trends of disease severity estimated by SAPS II and nursing workload estimated by NEMS in ICU patients admitted with ischemic stroke. ICU, intensive care unit; NEMS, Nine Equivalents of Nursing Manpower Use Score; SAPS II, Simplified Acute Physiology Score II. Data are presented as fraction of ICU patients at or above the threshold for the respective score (SAPS ≥ 39 or NEMS ≥ 21)

Fig. 4

Mortality trend over time in patients with ischemic stroke admitted to intensive care units in Switzerland. Data are presented as observed deaths per 1000 patients in ICU each year (points) and modeled trends (lines)