Women at higher risk for death by nighttime cardiac arrest than men
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The risk for sudden nighttime cardiac death is higher for women than men, and female sex is an independent predictor of nighttime events, according to research published in HeartRhythm.
“Sudden cardiac arrest is a major public health problem that affects at least 350,000 Americans a year, approximately 1,000 Americans a day. By the time the 911 call is made, 90% of these individuals are destined not to survive despite full efforts to resuscitate them. This represents the highest mortality from any human disease condition, and death occurs within minutes,” Sumeet Chugh, MD, Price Professor and associate director at Smidt Heart Institute, medical director at the Heart Rhythm Center and director of the Center for Cardiac Arrest Prevention and Division of Artificial Intelligence in Medicine at Cedars Sinai, Los Angeles, told Healio. “Women, individuals with known lung disease and those prescribed brain-affecting medications are at higher risk of sudden death during nighttime hours.”
Researchers evaluated 4,126 sudden cardiac death cases (66% men) from the population-based Oregon Sudden Unexpected Death Study. The 22.3% of cases occurring between 10 p.m. and 6 a.m. were compared with daytime cases.
Nighttime sudden cardiac death was more likely to occur in women compared with men (25.4% vs. 20.6%; P < .001). Chronic obstructive pulmonary disease (COPD)/asthma prevalence was higher among nighttime sudden cardiac deaths compared with daytime deaths (31.2% vs. 24.2%; P < .001). The daytime and nighttime groups did not differ in diagnosis of sleep apnea or use of continuous positive airway pressure.
Researchers observed female sex (OR = 1.3; 95% CI, 1.1-1.5; P = .001), somnolence/respiratory depression medications (OR = 1.2; 95% CI, 1.1-1.4; P = .008) and COPD/asthma (OR = 1.4; 95% CI, 1.1-1.6; P < .001) were independently associated with nighttime sudden cardiac death.
Among patients with sudden cardiac death, women took more central nervous system-affecting medications than men (1.9 vs. 1.4; P = .001). In both sexes, those who had sudden cardiac death at night were taking more central nervous system-affecting medications than those who had sudden cardiac death during the day (P < .001 for both).
According to Chugh, these findings indicate that health care providers should exercise caution in prescribing brain-affecting medications to individuals at elevated risk for sudden death due to heart disease, especially women.
“Especially since the likelihood of successful resuscitation from cardiac arrest is lower at nighttime compared to the daytime, future research is needed to understand the reasons behind these sex-specific differences,” Chugh said in an interview. “Such research could inform preventive measures to minimize nighttime sudden death in both women and men.”
For more information:
Sumeet Chugh, MD, can be reached at sumeet.chugh@cshs.org.
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