Sex-Based Differences in Short-Term Survival Following Out-of-Hospital Cardiac Arrest - European Medical Journal

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Sex-Based Differences in Short-Term Survival Following Out-of-Hospital Cardiac Arrest

1 Mins
Cardiology
Authors:
*Nertila Zylyftari,1,2,3 Filip Gnesin,2 Amalie Lykkemark Møller,4,5 Elisabeth Helen Anna Mills,6,7 Sidsel G. Møller,8 Britta Jensen,9 Kristian Bundgaard Ringgren,6,10 Frederik Folke,1,8,11 Gunnar Gislason,1,11,12 Christian Torp Pedersen,2,4,6 Christina Ji-Young Lee1,2

1. Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
2. Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
3. Department of Cardiology, Slagelse Hospital, Denmark
4. Department of Public Health, University of Copenhagen, Denmark
5. Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
6. Department of Cardiology, Aalborg University Hospital, Denmark
7. Department of Clinical Medicine, Aalborg University, Denmark
8. Copenhagen Emergency Medical Services, Denmark
9. Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Denmark
10. Department of Anaesthesiology and Intensive Care, North Denmark Regional Hospital, Denmark
11. Department of Clinical Medicine, University of Copenhagen, Denmark
12. The Danish Heart Foundation, Copenhagen, Denmark

*Correspondence to [email protected]
Disclosure:

Zylyftari has received support from European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the COST Action PARQ (grant agreement no. CA19137), supported by European Cooperation in Science and Technology (COST), and Helsefonden. Gnesin has received a grant from the Danish Cardiovascular Academy (Danish Heart Foundation and Novo Nordisk Foundation). Møller reports employment by Novo Nordisk A/S; and reports no disclosures relevant to the manuscript. Torp Pedersen has received a grant for epidemiological study from Novo Nordisk, and a grant for randomised study from Bayer. Lykkemark Møller, Mills, Jensen, Bundgaard Ringgren, Folke, Gislason, and Lee declare no conflicts of interest.

Acknowledgements:

The authors would like to thank TrygFonden, which supports the Danish Cardiac Arrest Registry, and Emergency Medical Services personnel, who filled out the case report for each out-of-hospital cardiac arrest for the Danish Cardiac Arrest Registry.

Citation:
EMJ Cardiol. ;11[1]:28-30. DOI/10.33590/emjcardiol/10309244. https://doi.org/10.33590/emjcardiol/10309244.
Keywords:
Out-of-hospital cardiac arrest (OHCA), sex, 30-day survival.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

Out-of-hospital cardiac arrest (OHCA) is the most common cause of cardiac-related death, and continues to be a public health burden with poor survival.1-3 Cardiovascular disease is the leading cause of death among females, who are known to have a different presentation compared to males.4 Although sex differences in cardiovascular diseases are well described, they have not been completely understood in survival after OHCA.

Therefore, the aim of this study was to examine sex differences in patient characteristics and the 30-day survival in patients with OHCA during 20 years of follow-up.

MATERIALS AND METHODS

The authors conducted an observational and register-based study, using nationwide Danish register data. All residents in Denmark have a unique person identification number, which enabled the authors to crosslink data from different registers on an individual level. From the Danish Cardiac Arrest Registry, they identified all patients with OHCA between 2001–2020, who were aged between 18–100 years, with a presumed cardiac cause of OHCA, which was not witnessed by emergency medical services during their arrest. Baseline characteristics were expressed as medians (quartile 1–3) or frequencies (percentages), and temporal trend analyses of 30-day survival were performed according to sex.

RESULTS

Between 2001–2020, a total of 50,270 patients with OHCA were included, 17,179 of whom were female (34%). Compared to males, females were older, with a median age of 76 years (quartile 1–3: 66–84), and were more likely to have a low socioeconomic status. Females had a higher burden of chronic obstructive pulmonary disease (19% versus 14%; p<0.001), and psychiatric disease (13% versus 8%; p<0.001). By comparison, males had more ischaemic heart disease (24% versus 17%; p<0.001) and diabetes (17% versus 14%; p<0.001).

Looking at medication use 180 days before OHCA, females had more prescriptions of antibiotics (48% versus 35%; p<0.001), steroids (18% versus 13%; p<0.001), and QT-prolonging drugs (17% versus 11%; p<0.001). Males had more prescriptions of anticoagulant drugs (17% versus 13%; p<0.001) and statins (32% versus 25%; p<0.001).

Related to cardiac arrest-related factors, OHCA experienced by females were more often in a private home (83% versus 74%; p<0.001), were less likely to be witnessed by a bystander (48% versus 53%; p<0.001), and were less likely to have shockable heart rhythm by emergency medical services arrival (14% versus 28%; p<0.001). No sex differences were observed for receiving cardiopulmonary resuscitation.

In analysis of the temporal trend of OHCA incidence and 30-day survival by sex during 2001–2020, an increase in 30-day survival for both sexes was observed (Figure 1). However, females had lower 30-day survival compared to males throughout the period of study. The average 30-day survival by sex during 2001–2010 versus 2011–2020 was 5% versus 8% for females, and 8% versus 15% for males, respectively.

Figure 1: Temporal trend of out-of-hospital cardiac arrest incidence and 30-day survival by sex during 2001–2020.
OHCA: out-of-hospital cardiac arrest.

CONCLUSION

Females had poorer prognostic patient characteristics and cardiac arrest-related factors compared to males. Although 30-day survival improved in both sexes during the period 2001–2020, females had lower 30-day survival compared to males. Further research is warranted to understand sex differences of patients with OHCA, in order to improve survival rates among females.

References
Gräsner J-T et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation. 2020;148:218-26. Berdowski J et al. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479-87. Gräsner J-T et al. European Resuscitation Council Guidelines 2021: epidemiology of cardiac arrest in Europe. Resuscitation. 2021;161:61-79. Vogel B et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet. 2021;397(10292):2385-438.

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