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Gender Differences in Cardiac Arrest Outcomes
Quick Takes
- Among patients resuscitated from out-of-hospital cardiac arrest, women have lower likelihood of survival to hospital discharge and survival with good neurological function compared with men.
- The difference in survival outcome between men and women is more pronounced among patients considered to have a more favorable prognosis.
Study Questions:
What is the relationship between the return of spontaneous circulation, survival to discharge on, and outcomes among men and women successfully resuscitated from out-of-hospital cardiac arrest?
Methods:
The authors analyzed Continuous Chest Compression trial and Amiodarone, Lidocaine, or Placebo Cardiac Arrest trial data on patients who were successfully resuscitated from an out-of-hospital cardiac arrest in order to assess the association between gender and survival after adjustment for patient and resuscitation characteristics. Do Not Resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) orders status were analyzed in relationship to baseline prognosis and post-resuscitation outcomes.
Results:
There were 4,875 successfully resuscitated patients. Among them, 37% were women and 63% were men. Women were older, received less bystander resuscitation, and had a lower rate of witnessed arrests and shockable rhythm. A significantly higher proportion of women received DNR orders and had WLST. Discharge survival was significantly lower in women (22.5% vs. 36.3%, p < 0.001). Women had significantly reduced discharge survival among patients who were not made DNR or did not have WLST. In contrast, no gender difference in survival was found among patients receiving a DNR or a WLST order. There were consistent patterns of association between gender and post-resuscitation outcomes.
Conclusions:
Among resuscitated out-of-hospital cardiac arrest patients, discharge to survival was significantly lower in women compared with men, especially among patients considered to have a favorable prognosis.
Perspective:
Prior literature has shown that women with out-of-hospital cardiac arrest differ from men on average by being generally older, less frequently experiencing a witnessed cardiac arrest, and less frequently presenting with initial shockable rhythm. At the same time, women have a higher likelihood of return of spontaneous circulation compared with men after accounting for baseline characteristics. The authors of the present study show that gender-based differences in survival outcomes are to an extent driven by social factors such as differences in end-of-life preferences and provider-level disparities in goals of care discussions. This should be further explored in future research.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Heart Arrest, Heart Failure, Out-of-Hospital Cardiac Arrest, Patient Discharge, Resuscitation Orders, Sex Differentiation, Survival
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