Treatment Goals Guide Cardiogenic Shock Care More Often in Women

Why It Matters

The findings highlight that communication framing, not biology, shapes gender gaps in life‑saving interventions, signaling a need for standardized decision‑making protocols to improve outcomes for women in cardiogenic shock.

Key Takeaways

• Women received invasive coronary angiography at 78% vs 86% in men
• PCI rates after angiography were similar between sexes (57% vs 58%)
• Patient/family preference cited twice as often for women’s treatment deferral
• Goals-of-care discussions guided decisions twice as frequently for women
• Sex not independent predictor of conservative management after multivariate adjustment

Pulse Analysis

Cardiogenic shock following an acute myocardial infarction remains the deadliest complication of heart attacks, affecting up to 10% of patients. The Northwell‑Shock Registry, presented at the SCAI 2026 Scientific Sessions, examined 1,374 cases across 13 New York hospitals to uncover how treatment choices differ by gender. While overall invasive coronary angiography use is high, women receive it at a lower rate than men, yet once the procedure is performed, percutaneous coronary intervention rates are virtually the same, suggesting that the disparity lies in the initial decision to intervene.

The study’s most striking insight is the role of communication in shaping those decisions. Women’s care pathways were twice as likely to be influenced by documented patient or family preferences and explicit goals‑of‑care conversations, whereas men’s treatment deferrals were more often attributed to complicating medical conditions or neurologic dysfunction. This pattern indicates that clinicians may frame risk‑benefit discussions differently for women, potentially leading to more conservative choices that affect survival. Addressing these conversational biases could narrow the mortality gap that has long disadvantaged female patients in acute cardiac emergencies.

For health systems and policymakers, the implications are clear: standardizing shared‑decision protocols and ensuring that discussions about invasive options are evidence‑based rather than perception‑driven could improve equity in cardiogenic shock care. Ongoing education for interventional cardiologists on gender‑sensitive communication, coupled with real‑time decision support tools, may help align treatment intensity with clinical need rather than gendered expectations, ultimately enhancing outcomes for both men and women.