Women who have cardiac arrest outside of a hospital setting are less likely to receive resuscitation from bystanders, according to new research published in European Heart Journal. The researchers, led by cardiologist They have Tanfrom the University of Amsterdam in the Netherlands, found that men and women did not receive equal treatment when they suffered cardiac arrest in the community.
An important factor in this was that people did not recognize that the women who collapsed were in cardiac arrest, leading to delays in calling emergency services and delays in providing resuscitation treatment. Cardiac arrest occurs when the heart goes into an irregular rhythm and then stops beating completely, which is different from a heart attack (or myocardial infarction).
Dr Tan explains, “We found that the poorer outcome in women is largely due to the fact that they were regarding half as likely to have a treatable rhythm compared to men.”
The treatable rhythm is the heart rhythm recorded when a person in cardiac arrest is connected to an electrocardiogram machine; it is very fast (often over 300 beats per minute) and chaotic. This rapid and irregular rhythm prevents the heart from beating in a coordinated manner so that there is no effective pumping function, and blood can no longer circulate through the body and into the heart, leading to cardiac arrest.
The death happens in minutes, unless the heart can be shocked at a normal rate by means of an electric current from a defibrillator. If this does not happen, then the treatable rhythm dissolves into a “flat line,” indicating the absence of any electrical activity in the heart.
At this point, it is too late for defibrillation to work and the only remaining option is chest compression to try to restore circulation enough for the heart to regain its electrical and mechanical activity. The ability to recognize and treat cardiac arrest within minutes is therefore crucial to being able to treat patients while they still have an initial treatable rhythm and before their heart stops.
Tan and his team analyzed data from all resuscitation attempts made by emergency services between 2006 and 2012 in a province in the Netherlands. They identified 5,717 treated out-of-hospital cardiac arrests during this period, 28% of which occurred in women.
Women were less likely than men to receive a bystander resuscitation attempt
They found that women were less likely than men to receive a resuscitation attempt from a bystander (68 vs. 73%), even when someone was there to witness the collapse (69 vs. 74%). Survival from cardiac arrest to hospital admission was lower in women (34 vs 37%), and women were less likely to survive from admission to hospital discharge (35 versus 55%) and found several reasons that might explain this difference.
“Even when we adjusted our results to account for pre-existing conditions and factors related to how providers provided resuscitation, for example, how long it took for an ambulance to arrive or defibrillation time following cardiac arrest, we still found that women were half as likely as men to have a reversible rhythm,” Tan said.
“This suggests that the lower proportion of women with a reversible rhythm is not fully explained by women being more likely to have pre-existing conditions or by different resuscitative factors, and other factors, as yet undiscovered, also play a role.” . However, when we looked only at cardiac arrest victims who had a reversible rhythm, we found that there were no differences in overall survival rates between men and women,” she stresses.
Differences in treatment
The researchers also found differences in the way the women were treated at the hospital. They were less likely to be diagnosed with a heart attack heart attack and less likely to undergo coronary angiography or percutaneous coronary intervention.
The scientists say that one possible reason why fewer women have a treatable rhythm when they arrive at emergency services may be because fewer women than men tend to have cardiac arrest when others are watching: for demographic reasons, there are more older women living alone than men, and because the symptoms of a heart attack – one of the most common causes of cardiac arrest – may not be recognized as quickly in women.
“People may be less aware that cardiac arrest can occur as frequently in women as it does in men, and women themselves may not recognize the urgency of their symptoms, explains Tan. Women may experience symptoms of an impending attack symptoms that are less easy to interpret, such as fatigue, fainting, vomiting, and neck or jaw pain, while men are more likely to have typical complaints, such as chest pain.
The researchers call for a range of measures to address the problem of survival differences between men and women, ranging from public awareness campaigns regarding heart attacks and cardiac arrests in women to reorganizing health care systems to provide more resuscitation. women, particularly those living on their own, for example, through wearable devices that monitor heart rate and circulation and can send alerts to monitoring systems.
“As cardiac arrests occur more frequently outside of hospital settings in the general population, much is likely to be gained by raising awareness in society that cardiac arrest is just as common in women as it is in men, but can have different symptoms. Given the short window available to save the patient’s life, every minute in this early phase counts; Help, even just a call to 911, is crucial. Therefore, raising awareness through public campaigns might have a major impact on women’s survival. “Inpatient treatment also seems to be different, it’s a finding that can be applied now and may be easier to implement,” she concludes.
Among the limitations of the study are that data on pre-existing conditions were missing in 27.5% of heart attack patients, although in both cases the missing data was evenly distributed between the sexes. The scientists had no information regarding symptoms that patients may have reported before their heart attacks, which may have influenced how quickly bystanders can make an emergency call.
