TCT-524 Sex Differences in Survival From Out-of-Hospital Cardiac Arrest: Insights From the National Inpatient Sample

Introduction: Cardiac catheterization is recommended for patients resuscitated from out-of-hospital cardiac arrest (OHCA) with a suspected cardiac etiology. Women are less likely than men to receive cardiac catheterization in other presentations of cardiovascular disease, but it remains unknown whether this disparity extends to OHCA. Objective: To determine whether patient sex is associated with undergoing cardiac catheterization after OHCA. Methods: We included all adult cases in the 2011 California Office of Statewide Health Planning and Development (OSHPD) database with a present-on-admission diagnosis of cardiac arrest (ICD-9-CM 427.5) or sudden cardiac death (ICD-9-CM 798) who were admitted from the emergency department to an acute care hospital. Data extracted from the OSHPD database included patient demographics, diagnoses, and procedures. ICD-9-CM procedure codes from the OSHPD database were used to identify patients who received cardiac catheterization. To determine factors associated with undergoing cardiac catheterization, we used a hierarchical logistic regression model that included age, sex, race, ethnicity, insurance type, ventricular arrest rhythm, and treatment at a hospital with 24/7 percutaneous coronary intervention capability. Results: We studied 4493 men and 3287 women admitted following OHCA. Women were older (median age 70 vs 64 years; p<0.001), had had fewer ventricular arrest rhythms (21.8% vs 31.7%; p<0.001), and received fewer cardiac catheterization procedures [12.5% vs 21.4%; p<0.0001]. This sex difference in cardiac catheterization persisted in the multivariable hierarchical model (adjusted OR 0.65; 95% CI 0.57-0.76; p<0.0001) and in a subgroup analysis including only patients with ventricular arrest rhythms (adjusted OR 0.63; 95% CI 0.51-0.78; p<0.0001) Conclusion: Sex differences exist in cardiac catheterization following resuscitation from OHCA. Future efforts should focus on understanding and resolving these differences.

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Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz297 ◽

2019 ◽

Vol 40 (47) ◽

pp. 3824-3834 ◽

Cited By ~ 24

Author(s):

Marieke T Blom ◽

Iris Oving ◽

Jocelyn Berdowski ◽

Irene G M van Valkengoed ◽

Abdenasser Bardai ◽

...

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Sex Differences ◽

Hospital Admission ◽

Survival Rates ◽

Hospital Treatment ◽

Care Utilization ◽

Entire Study ◽

Hospital Cardiac Arrest ◽

Resuscitation Attempt

AbstractAimsPrevious studies on sex differences in out-of-hospital cardiac arrest (OHCA) had limited scope and yielded conflicting results. We aimed to provide a comprehensive overall view on sex differences in care utilization, and outcome of OHCA.Methods and resultsWe performed a population-based cohort-study, analysing all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands (2006–2012). We calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis. Additionally, we provided an overview of sex differences in overall survival and survival at successive stages of care, in the entire study population and in patients with SIR. We identified 5717 EMS-treated OHCAs (28.0% female). Women with OHCA were less likely than men to receive a resuscitation attempt by a bystander (67.9% vs. 72.7%; P < 0.001), even when OHCA was witnessed (69.2% vs. 73.9%; P < 0.001). Women who were resuscitated had lower odds than men for overall survival to hospital discharge [OR 0.57; 95% confidence interval (CI) 0.48–0.67; 12.5% vs. 20.1%; P < 0.001], survival from OHCA to hospital admission (OR 0.88; 95% CI 0.78–0.99; 33.6% vs. 36.6%; P = 0.033), and survival from hospital admission to discharge (OR 0.49, 95% CI 0.40–0.60; 33.1% vs. 51.7%). This was explained by a lower rate of SIR in women (33.7% vs. 52.7%; P < 0.001). After adjustment for resuscitation parameters, female sex remained independently associated with lower SIR rate.ConclusionIn case of OHCA, women are less often resuscitated by bystanders than men. When resuscitation is attempted, women have lower survival rates at each successive stage of care. These sex gaps are likely explained by lower rate of SIR in women, which can only partly be explained by resuscitation characteristics.

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Sex Differences in “Do Not Attempt Resuscitation” Orders After Out-of-Hospital Cardiac Arrest and the Relationship to Critical Hospital Interventions

Clinical Therapeutics ◽

10.1016/j.clinthera.2019.03.017 ◽

2019 ◽

Vol 41 (6) ◽

pp. 1029-1037 ◽

Cited By ~ 1

Author(s):

Sarah M. Perman ◽

Bonnie J. Siry ◽

Adit A. Ginde ◽

Anne V. Grossestreuer ◽

Benjamin S. Abella ◽

...

Keyword(s):

Cardiac Arrest ◽

Sex Differences ◽

Resuscitation Orders ◽

The Relationship ◽

Hospital Cardiac Arrest

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Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.186 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Pavitra Kotini-Shah ◽

Oksana Pugach ◽

Ruizhe Chen ◽

Marina Del Rios ◽

Kimberly Vellano ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

Sex Differences ◽

Coronary Angiography ◽

Neurological Outcome ◽

The United States ◽

Neurological Outcomes ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

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