Why Do Women Die More Of Cardiac Arrest Than Men?

Why Do Women Die More Of Cardiac Arrest Than Men? Sudden cardiac arrest (SCA) is one of the biggest killers in the US and globally. Each year, more than 500,000 people in America suffer from cardiac arrest, with only 8% surviving to hospital discharge. Cardiac arrest occurs when the heart’s electrical impulses, which keep the heart beating, are disrupted thereby stopping the heart or sending it into an irregular rhythm.

Cardiac arrest and heart attack are often conflated but they are different conditions, with the latter being brought about by blockage of the coronary artery which stops blood flow to the heart. If a heart attack is left untreated, it leads to SCA but the inverse is not true.

It is a common myth that women do not suffer from cardiac arrest. Granted, the absolute number of women going into SCA is lower than that of men, emerging research is painting a grave picture for women who do go into cardiac arrest.

Women who suffer from aSCA are significantly less likely than men to survive to hospital discharge.

Why is that the case?

There are many attenadant reasons for this disparity in gender survival rates.

Bystander respoanse is very disparate in terms of how women and men in SCA get treated. This tendency mirrors response for other types of medical emergencies requiring CPR. Bystanders are generally less likely to offer first aid to women than they do men especially in public settings. In a study carried out by a team from the University of Amsterdam, it was found that a woman in cardiac arrest is 27% less likely to receive CPR from bystanders than a man in the same situation. This tendency has been attributed to a number of factors including reluctance by bystanders to touch a woman’s breast area, and perceptions of women as delicate and likely to be injured by the force used during application of CPR.
Another reason, which traces back to insidious myths about cardiac arrest and even disrupts CPR practices by emergency response personnel is the assumption that women do not suffer cardiac arrest. Lay witnesses of a woman collapsing will usually assume milder conditions like syncope (fainting), low blood pressure and dehydration. Even when a witness to a woman in SCA is adequately equipped with BLS tools including an AED and CPR training, they are likely to overlook possible cardiac arrest.
Additionally, women tend to display less obvious warning signs of SCA induced by a heart attack than men. Generally, when women have warning symptoms before a heart attack, they tend to be milder signs like fatigue, nausea and neck pain, whereas more men report chest pain in the moments leading to a heart attack and their eventual cardiac arrest. Compounding the situation further, analysis of antemortem data shows that women show less pronounced markers of SCA in electrocardiogram (ECG) profiles, which may preempt adequate intervention especially in hospital settings.
Perhaps more critically, the pathological manifestation of cardiac arrest in women is more critical than in men. This may be attributed to the fact that women in SCA have a lower rate of shockable initial rhythm (SIR) than men- 33% of women had a shockable rhythm compared to 52% among men. The SIR refers to the heart rhythm when the victim is first connected to a defibrillator. Shockable rhythms include ventricular tachycardia and ventricular fibrillation and non-shockable rhythms include asystole and pulseless electrical activity. When adjusted for comorbidities and resuscitation typology, SIR is the biggest predictor of surviving an out-of-hospital cardiac arrest. As a result, the window for resuscitation is significantly narrower for women and therefore they need to be defibrillated earlier than men. Women who received resuscitation attempts were still less likely to survive than their men counterparts (12.5% vs 20.1%).
It is also important to mention the factor of location and circumstance, mediated by daily sex-based disparities in daily activities as a contributing factor. Due to the fact that women are more likely to live alone and to be indoors during the day, they are more likely to suffer an unwitnessed SCA, leaving them without the possibility of receiving CPR. Among men, there is a high incidence of SCA during exercise, where trained EMS personnel and lay responders are more likely to be present.

Why education is the key to reversing this trend

The public approach for addressing cardiac arrest has largely been anchored on widespread education of the public and medical personnel. This has been shown to bear fruits. Public education once again lends itself as a possibly effective remedy to change the dire situation that women are faced with when in SCA. In the same way that concerted public sensitization on the use of AEDs and CPR resulted in significant increases in overall SCA survival rates, a similar campaign of sensitization may yield positive results with regards to women’s awareness and survival of cardiac arrest.

In CPR training, more often than not, the mannequins availed for CPR practice are male and the anatomical physique of women’s chest area is not well represented. In other words, people practice CPR with mannequins that have no breasts. So, when they encounter a woman who needs CPR, they find themselves in an unfamiliar or uncomfortable position. There have been efforts by various initiatives to train BLS skills using female torsos complete with breasts in the hope that it would induce comfort when a person is witness to a real SCA emergency.

In summary, there needs to be a concerted effort by health stakeholders to incorporate information about heart health disparities in BLS curriculums for both the lay responder and EMS personnel. Further research into markers of cardiac arrest specific to women also needs to be conducted, with the possibility of creating preemptive action manuals for people witnessing cardiac arrests.