Gender Gap Found in Cardiac Arrest Care, Outcomes

Gender Gap Found in Cardiac Arrest Care, Outcomes

Study Highlights

  • Women treated at a hospital after cardiac arrest may be less likely than men to receive potentially life-saving procedures.
  • The number of cardiac arrest patients treated at hospitals increased and in-hospital death rates have fallen for both sexes, however women were less likely to survive, according to a new study.

DALLAS, TX — Women who have a cardiac arrest are less likely than men to receive potentially life-saving procedures such as angiography to look for blocked coronary arteries or angioplasty to open them, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

The study indicates such procedures have helped boost cardiac arrest survival rates, said Luke Kim, M.D., study lead author and assistant professor of medicine in the cardiology division of Weill Cornell Medical College in New York. “But the troublesome part of our paper is that just as with many other treatments we’re still not doing as good a job with women as men. Women tend to get less immediate care when time is essential.”

The study is the first to report sex-based disparities across a representative spectrum of cardiac arrest patients from more than 1,000 U.S. hospitals nationally. During the 10-year study, in-hospital death rates fell for both sexes, but remained higher for women. Of those who were treated in hospital for cardiac arrest, 64 percent of women died compared to 61 percent of men. 

Using a database of hospital discharge records known as the Nationwide Inpatient Sample, researchers analyzed more than 1.4 million cases in which cardiac arrest patients were transported alive to acute-care hospitals from 2003 through 2012. During that time, the number of cardiac arrests increased by 14 percent.

Adjusting for factors including patient age, health, hospital characteristics and previous cardiac procedures, researchers also found that women who had a cardiac arrest from a shockable rhythm were:

  • 25 percent less likely to receive coronary angiography;
  • 29 percent less likely to have angioplasty, also known as percutaneous coronary intervention (PCI);
  • 19 percent less likely to be treated with therapeutic hypothermia, in which body temperature is lowered to help improve odds of survival and reduce risk of brain damage.

As a group, women in the study were older than men and were less likely to have been previously diagnosed with coronary artery disease. They were more likely to have other health problems, such as congestive heart failure, high blood pressure, obesity and other issues, and to have cardiac arrest caused by problems other than a blood vessel blockage, such as pulmonary embolism.

The study cannot pinpoint causes of the gender gap, the authors said.

Kim said better educational outreach across the community — not just to doctors, nurses, and first responders, but citizens on the street — could improve cardiac arrest survival rates. More people should be taught about cardiac arrest, how to perform CPR, and what defibrillators do.

Unlike some of the other disorders, “cardiac arrest is one of the few medical emergencies where there’s a huge impact due to how the public responds to it. If someone can get to a patient right away and do CPR, that patient has a chance,” Kim said

Cardiac arrest occurs when the heart abruptly stops functioning due to malfunction of its electrical system. In 2014, about 356,500 people in the United States suffered out-of-hospital cardiac arrests; only12 percent of those treated by emergency medical services survived.

Co-authors are Patrick Looser, M.D.; Rajesh V. Swaminathan, M.D.; James Horowitz, M.D.; Oren Friedman, M.D.; Ji Hae Shin, M.D.; Robert M. Minutello, M.D.; Geoffrey Bergman, M.D.; Harsimran Singh, M.D.; S. Chiu Wong, M.D. and Dmitriy N. Feldman, M.D. Author disclosures are on the manuscript.

The Michael Wolk Heart Foundation and the New York Cardiac Center funded the study.

SOURCE: American Heart Association

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Bob Trenkamp's picture
Bob Trenkamp wrote 3 years 16 weeks ago

Gender gap in cardiac arrest survival

In my ten year (post retirement) career as a paramedic and medical first responder I observed a very strange difference in how the two genders with a heart attack present.

Males most often complained of chest pain, a sense of the room being stuffy, diaphoresis. Sometimes the pain radiated to the neck and arm.

Females sometimes had the same symptoms, but there was one other female presentation that I've never observed in a male. When I arrived at the woman's home - usually 3am or so - I would ask how she was doing, and she would reply "I must have gotten food poisoning at the [name of restaurant] last evening - I went to bed about 9 pm but soon felt nauseated." Have you vomited? "no."

A female with a persistent sense of nausea without vomiting early in the morning has nearly always been a female with an AMI in my experience.

Another gender difference I observed on the ambulance and in the Emergency Department was - in general - the males were not bashful about telling me that they hurt and that they thought there was a problem. The females frequently "didn't want to bother us."

I suspect - without a pile of data to analyze - that the average time from noticing symptoms to the time action is taken is longer for females than for males.

It would be interesting to parse the data in the study you referenced into two piles: women with female physician vs. male physician to see whether the delayed response persisted in both groups.

Bob

Bob Trenkamp, President
Saving Lives In Chatham County
www.slicc.org

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