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Women lag behind men in lifesaving cardiac arrest treatments
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Women are less likely than men to receive potentially lifesaving procedures such as angiography and PCI when having cardiac arrest, according to study results published in the Journal of the American Heart Association.
“The troublesome part ... 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,” Luke Kim, MD, assistant professor of medicine, cardiology division, Weill Cornell Medical College, New York, said in a press release.
Luke Kim
Researchers sought to expand the available data on sex-based disparities in treatment and outcomes after cardiac arrest. They analyzed data from the Nationwide Inpatient Sample on 1,436,052 patients who arrived alive at acute care hospitals from 2003 to 2012. Of that cohort, 45.4% were women.
Sorted by treatment
Researchers stratified the cohort according to treatment received: angiography, PCI and therapeutic hypothermia, in which body temperature is lowered to improve survival odds and reduce the risk for brain damage.
Sections of the study also were differentiated between cardiac arrest types: non-shockable rhythms (pulseless electrical activity/asystole) or shockable rhythms (ventricular tachycardia [VT] and ventricular fibrillation [VF]).
After adjusting for multiple demographic, procedural and medical variables, the researchers found that the employment of angiography in all cardiac arrests increased in men (16.5% to 19.9%; P for trend < .001) vs. women (12.1% to 13.4%; P for trend < .001). The use of PCI rose over time in men (7.2% to 10.1%; P for trend < .001) compared with women (4.8% to 5.8%; P for trend < .001), whereas the use of therapeutic hypothermia increased for men (0% to 3.2%; P for trend < .001) vs. women (0% to 2.3%; P for trend < .001).
Large percentage gaps
Women with VT/VF cardiac arrests were 29% less likely than men to receive angioplasty and 25% less likely than men to have angiography, the researchers wrote. Women also had lower odds than men of therapeutic hypothermia treatment (adjusted OR = 0.81; 95% CI, 0.76-0.87) in VT/VF arrests, but not for pulseless electrical activity or asystole cardiac arrests.
Kim and colleagues found that in-hospital mortality declined in women (2003, 69.1%; 2012, 60.9%; P for trend < .001) and in men (2003, 67.2%; 2012, 58.6%; P for trend < .001), but in-hospital mortality throughout the study period was significantly higher in women (64% vs. 61.4%; adjusted OR = 1.02; P < .001). This was driven by differences in those with VT/VF arrest (49.4% vs. 45.6%; adjusted OR = 1.1; P < .001).
The researchers also wrote that women were less likely than men to receive ventricular assist or intra-aortic balloon pump support devices and were also less likely to have been previously diagnosed with CAD.
“Cardiac arrest is one of the few medical emergencies where there’s a huge impact due to how the public responds,” Kim said in the release. “If someone can get to a patient right away and [perform] CPR, that patient has a chance.” – by James Clark
Disclosure: One researcher reports receiving consulting and speaking fees from Abbott Vascular, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly and Pfizer. The other researchers report no relevant financial disclosures.
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