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Medscape
12-06-2025
- Health
- Medscape
Women With ILD Fare Better After ICU Care
Women admitted to ICU for interstitial lung disease (ILD) had shorter hospital stays and a lower risk for death than men, based on a new analysis of more than 800,000 individuals. Although previous studies have shown gender-based disparities in disease progression and severity for ILD based on subtype, data on the effect of gender on ICU outcomes in these patients are limited, according to Matthew Viggiano, MD, an internal medicine resident at Temple University Hospital, Philadelphia, and colleagues. In a study presented at the American Thoracic Society (ATS) 2025 International Conference, the researchers analyzed data from the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project for the period from 2016 to 2018. They identified 810,295 adults aged 18 years or older hospitalized with ILD, of whom 42,080 received ICU care. Of these, 46.7% were women. Female patients were significantly younger than male patients (mean age, 66.9 vs 69.1 years), more likely to be African American (17.0% vs 10.9%), and less likely to be Caucasian (63.7% vs 69.2%; P < .001 for all). Mortality was significantly lower in women than in men (40.5% vs 48.1%) even after adjusting for confounders including age, race, and comorbidities, and this difference was the most striking finding, Viggiano said in an interview. 'It also surprised us that these women tended to have a shorter length of hospital stay, given many came from lower-income areas,' he said. ICU stays were defined using International Classification of Diseases (ICD) codes for central line placement and mechanical ventilation. Overall, hospital stays for female patients lasted 1.15 days less than hospital stays for male patients. Female patients also were significantly more likely than male patients to come from lower-income ZIP codes (38.3% vs 33.2%) and less likely to have a history of tobacco use disorder (35.0% vs 43.9%; P < .001 for both). The reasons for the disparities remain unclear, but new studies suggest that hormones may play a role in disease progression and severity, Viggiano told Medscape Medical News . 'For example, estrogen has been implicated in modulating immune responses and fibrotic processes in the lungs via downregulating profibrotic pathways,' he said. 'Additionally, women may have lower threshold to seek medical attention or follow-up, leading to earlier intervention and management of ILD,' he noted. Other comorbidities unrelated to ILD also may contribute to morbidity and hospital length of stay, he added. 'Overall, recognizing these disparities is a key step toward more personalized treatment strategies, and our hope is that this research will prompt further studies to fully understand and address the underlying causes,' said Viggiano. Not Time for Gender Neutral Treatments Although the results suggest that clinicians should be aware that gender could influence ILD prognosis, the data do not suggest a need to advocate for entirely separate protocols as yet, Viggiano said. 'Instead, we encourage clinicians to recognize that men may have unique risk factors and might require more aggressive monitoring or early interventions; further studies will help refine specific management strategies,' he said. 'We believe evaluating for mortality and hospital stay in different subtypes of ILD would be an immediate future direction for the project,' said Viggiano. The investigation of specific biological, immunologic, and social factors also must be an area of focus, he said. 'Understanding why women fare better could lead to targeted therapies, especially for men who are at higher risk of poor outcomes, and ultimately to more personalized approaches to ILD care,' he added. To that end, Viggiano and colleagues intend to conduct prospective studies to explore specific biological markers and social determinants in men and women with ILD. 'We'll also look at the influence of treatment interventions, medication use, and rehabilitation services on outcomes. Ultimately, we'd like to identify targeted strategies to reduce the mortality gap and enhance care for both genders,' he told Medscape Medical News . Data Reinforce Differences 'As more treatments for interstitial lung diseases emerge, it is important that we now start focusing on which populations get the greatest benefit for specific treatments,' said Anthony Faugno, MD, a pulmonologist at Tufts Medicine, Boston, in an interview. To that end, the authors of the current study used data from the NIS to ask important questions about how sex, demographics, and socioeconomic factors affect patient outcomes, said Faugno, who was not involved in the study. Were You Surprised by Any of the Findings? Why or Why Not? Biologically important differences in hormones between men and women are known to affect the way a given disease behaves; therefore, it is important to have representative samples of diverse sex and race in clinical trials to ensure the generalizability of therapy, Faugno told Medscape Medical News . The current study findings were not surprisingbut reinforce the value of a diverse population using a large, nationally representative sample, he said. The current study findings may not directly affect clinical practice, as the results were based on ICD codes that cover many different diagnoses, Faugno noted. However, as the authors suggest, 'I do think it informs additional research directions, such as doing a similar analysis in specific interstitial diseases,' he said. The current study addresses a global catch-all term of ILD, which may include many different pathologies that respond to different treatments, said Faugno. 'A future analysis that addressed the gender disparities in more specific diagnoses would add to our understanding and help patients better understand how they may respond to a specific therapy,' he said.
Medscape
14-05-2025
- Health
- Medscape
Yes, You Can Die From a Broken Heart
This transcript has been edited for clarity. Welcome to Impact Factor , your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson from the Yale School of Medicine. A patient comes crashing into the emergency room with severe chest pain. The EKG looks like this: As a doctor, if you see this, you're calling the cardiac cath lab. This is an ST-elevation myocardial infarction — the big one — indicative of a blood clot blocking blood flow to a large section of the heart. The sooner you get that blood clot out, the better chance the patient has to survive. So the patient is rushed to the cath lab, and they find… nothing. Clear coronaries. No blood clot. Further questioning reveals that the patient, an older woman, lost her husband recently. This is stress-induced cardiomyopathy, medically known as Takotsubo cardiomyopathy (TC). It's the pathophysiologic manifestation of a broken heart. First described in 1991, Takotsubo syndrome occurs in the setting of deep psychological, emotional, or physical stress. Despite being aware of it for decades, we still don't really understand what the underlying processes are, though they probably have something to do with an excess of catecholamines. But a new study cobbles together data from across the United States to give us new insight into the epidemiology and outcomes of the syndrome. Interestingly, women are much more likely to get a broken heart. But men are more likely to die from it. We got a nice Takotsubo analysis this week, thanks to this article in the Journal of the American Heart Association , from Mohammad Movahed of the University of Arizona and colleagues. They used a database called the National Inpatient Sample. It is what it sounds like: a sample of data from patients hospitalized around the nation. It's a weighted dataset; it doesn't have data from every hospitalization, but individual patients in the dataset can stand in for those who aren't there. This allows you to estimate stuff like the total number of admissions for a certain diagnosis across the whole country. The researchers flagged admissions with a diagnosis code for TC. All told, they identified 39,984 individuals with the syndrome, which scales up to an estimated 199,890 US admissions in total from 2016-2020 — about 40,000 admissions per year in this country. It's not a huge number; there are around 600,000 admissions per year for acute myocardial infarction, but it's not exactly rare. Women were much more likely to have TC; 83% of all the cases were female. You can see here a slight increase in prevalence over time, but nothing dramatic, especially considering that the last year of data would encompass the start of the COVID pandemic. If we break down the incidence by age group, you can see an interesting increase in risk as people got older, with a near doubling of risk after age 45. People have hypothesized that estrogen may play a protective role in this condition, so we might be seeing an increased risk associated with menopause here, but I would have liked to see this stratified by sex to be certain. The authors compare outcomes among those hospitalized with TC to outcomes of hospitalized patients without TC. That feels like an overly broad control group, to be honest, so it isn't surprising that there is, for example, a 12-fold risk for cardiogenic shock compared with the general inpatient population. Individuals admitted to the hospital with other types of heart disease, or a heart attack, would have told us a bit more about the unique risks of TC. Maybe next time. Of course, the worst possible outcome is death, and 6.58% of the patients with TC died during their admission. That's against a background rate of 2.4% of all other patients in the hospital — about a threefold increase in mortality risk. But men with TC were much more likely to die than women, with an 11.2% mortality rate compared with 5.5% among women. This has also been increasing over time. There's no clear explanation for the discrepancy. Men were more likely to develop the condition from physical, as opposed to emotional, stress, and that might change the risk profile. Alternatively, it's possible that this is a 'stubborn man' phenomenon; men might be less likely to go to the hospital when symptoms are mild, so if they do make it to the hospital, they are in worse shape. Take care of yourselves, guys. This paper may have raised more questions than answers, but I appreciate the opportunity to highlight something we often forget — that there is a profound connection between our minds, our emotions, and our bodies, and that connection is not purely subjective. Takotsubo cardiomyopathy is a potentially fatal disease, with all the risks of a major heart attack and without a convenient treatment like cardiac catheterization. And though I hope most of us never experience the levels of stress — emotional or otherwise — that would precipitate this disease, the very existence of a syndrome like this shows us that stress can be toxic. None of us can live stress-free lives, of course, and I'm not sure what the dose-response effect is, but in the end, perhaps knowing that how we feel affects how we feel can help us better manage how we feel.
