Out-of-hospital cardiac arrest in men and women

Abstract

Background-The incidence of sudden cardiac death is roughly 3 times greater in men than in women. However, in patients treated for out-of-hospital cardiac arrest, the relationships between sex and survival after adjustment for age and cardiac rhythm are unclear. Methods and Results-In this retrospective cohort study, we examined 7069 men and 2582 women who were treated for out-of-hospital cardiac arrest in Seattle and suburban King County between 1990 and 1998. We compared successful prehospital resuscitation (hospital admission) and survival from event to discharge in men and women. Women had markedly reduced rates of ventricular fibrillation (VF), slightly older age, fewer witnessed arrests, and fewer arrests in public locations than men. Although their unadjusted resuscitation rate was lower (29% versus 32%, PϽ0.0001), women had a greater likelihood of resuscitation than men after adjustment for VF (odds ratio [OR] 1.13; 95% confidence interval [CI], 1.03 to 1.25) and after adjustment for VF plus additional factors (OR, 1.27; 95% CI, 1.14 to 1.41). The difference in resuscitation rates between men and women decreased as they aged (test for trend, PϽ0.0001). Unadjusted survival rates were also lower in women than in men (11% versus 15%, PϽ0.0001). Women had similar survival after adjustment for VF (OR, 0.97; 95% CI, 0.85 to 1.11) and after adjustment for VF plus additional factors (OR, 1.09; 95% CI, 0.93 to 1.27). Conclusions-The lower unadjusted resuscitation and survival rates observed in women were primarily due to women's lower incidence of VF, a relatively favorable cardiac rhythm. After adjustment for VF and other factors, women had higher resuscitation rates than men, but similar rates of survival from event to discharge.

Current burden of sudden cardiac death: Multiple source surveillance versus retrospective death certificate-based review in a large U.S. community

“…In the present study, among patients with primary cardiac arrest who underwent resuscitation, women had a lower prevalence of VF and a higher rate of pulseless electrical activity as the presenting arrhythmia. This trend is similar to previously reported findings (18). There were no differences between genders with respect to the overall survival rate.…”

“…In the present study, the gender difference in SCD occurrence was low (57% male vs. 43% female), whereas most studies of primary cardiac arrest have reported a threefold higher incidence in men compared with women (18). This probably reflects the differences in the way cases were ascertained and defined in the two types of populations.…”

A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy

“…There were some differences in the demographics of the two cohorts, but these are unlikely to explain the observed effect. Women have had either equivalent or improved outcomes during resuscitation in previous studies (37)(38)(39)(40)(41)(42)(43)(44)(45), and, while there is a paucity of data about obesity and CPR, obesity in general is associated with worse cardiovascular outcomes, a trend opposite to that seen in this study (46). The regression analysis supported the concept that these differences and that of ACE inhibitor use could not explain the change in outcome after program initiation.…”

Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis

“…to have less initial shockable rhythm 19,20 and less bystanderwitnessed SCA, 19,21 two keys factors usually associated with low survival. However, some studies observed a survival advantage for women 22,23 .…”