Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death Study
Studies evaluating a possible survival advantage from sudden cardiac arrest (SCA) in women have produced mixed results possibly due to a lack of comprehensive analyses. We hypothesized that race, socioeconomic status (SES), and elements of the lifetime clinical history influence gender effects and need to be incorporated within analyses of survival.
Cases of SCA were identified from the ongoing, prospective, multiple-source Oregon Sudden Unexpected Death Study (population approximately one million). Subjects included were age ≥18 years who underwent attempted resuscitation by EMS providers. Pearson’s chi-square tests and independent samples t tests or analysis of variance were used for univariate comparisons. We evaluated gender and race differences in survival adjusted for age, circumstances of arrest, disease burden, and socioeconomic status using a logistic regression model predicting survival.
A total of 1,296 cases had resuscitation attempted (2002–2007; mean age 65 years, male 67%). Women were older than men (68 vs. 63 years, p < 0.0001) and were more likely to have return of spontaneous circulation (41% vs. 33%, p = 0.004). Women were more likely to present with pulseless electrical activity (PEA) and asystole (p < 0.0001), and overall, PEA was more common among African Americans (p = 0.04). Higher survival to hospital discharge was observed in women compared to men presenting with ventricular fibrillation/tachycardia (34% vs. 24%, p = 0.02) or with PEA (10% vs. 3%, p = 0.007). In a multivariate model adjusting for age, race, presenting arrhythmia, arrest circumstances, arrest location, disease burden, and SES, women were more likely than men to survive to hospital discharge [odds ratio 1.85; 95% confidence interval (1.12–3.04)].
Despite older age, higher prevalence of SCA in the home, and higher rates of PEA, women had a survival advantage from ventricular fibrillation and pulseless electrical activity.
KeywordsSudden cardiac arrest Survival Women Pulseless electrical activity Ventricular fibrillation Resuscitation
The authors would like to acknowledge the significant contribution of American Medical Response, Portland/Gresham fire departments, and the Oregon State Medical Examiner’s office. This study was funded in part by the National Heart Lung and Blood Institute R01HL088416, R01 HL088416-03S1, and R01 HL105170 to Dr. Chugh. This work was also supported by an Award from the American Heart Association and Philips Healthcare to Dr. Teodorescu. Dr. Chugh is the Pauline and Harold Price Professor of Cardiac Electrophysiology at the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Conflict of interest
- 3.Cummins, R. O., Ornato, J. P., Thies, W. H., & Pepe, P. E. (1991). Improving survival from sudden cardiac arrest: The “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation, 83, 1832–1847.PubMedCrossRefGoogle Scholar
- 10.Wigginton, J. G., Pepe, P. E., Bedolla, J. P., DeTamble, L. A., & Atkins, J. M. (2002). Sex-related differences in the presentation and outcome of out-of-hospital cardiopulmonary arrest: A multiyear, prospective, population-based study. Critical Care Medicine, 30, S131–S136.PubMedCrossRefGoogle Scholar
- 20.Chugh, S. S., Jui, J., Gunson, K., Stecker, E. C., John, B. T., Thompson, B., et al. (2004). Current burden of sudden cardiac death: Multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. Journal of the American College of Cardiology, 44, 1268–1275.PubMedCrossRefGoogle Scholar
- 21.Stecker, E. C., Vickers, C., Waltz, J., Socoteanu, C., John, B. T., Mariani, R., et al. (2006). Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: Two-year findings from the Oregon Sudden Unexpected Death Study. Journal of the American College of Cardiology, 47, 1161–1166.PubMedCrossRefGoogle Scholar
- 22.Chugh, S. S., Uy-Evanado, A., Teodorescu, C., Reinier, K., Mariani, R., Gunson, K., et al. (2009). Women have a lower prevalence of structural heart disease as a precursor to sudden cardiac arrest: The Ore-SUDS (Oregon Sudden Unexpected Death Study). Journal of the American College of Cardiology, 54, 2006–2011.PubMedCrossRefGoogle Scholar
- 23.Chugh, S. S., Reinier, K., Singh, T., Uy-Evanado, A., Socoteanu, C., Peters, D., et al. (2009). Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: The Oregon Sudden Unexpected Death Study. Circulation, 119, 663–670.PubMedCrossRefGoogle Scholar
- 25.Sudden cardiac death (1985). Report of a WHO Scientific Group. World Health Organization Technical Report Series 726:5–25.Google Scholar
- 33.Herlitz, J., Ekstrom, L., Wennerblom, B., Axelsson, A., Bang, A., & Holmberg, S. (1994). Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital. British Heart Journal, 72, 408–412.PubMedCrossRefGoogle Scholar