Although death and disability have been significantly reduced by bystander interventions such as cardiopulmonary resuscitation, out-of-hospital cardiac arrest (OHCA) was the third leading cause of health loss due to disease in the U.S. behind ischemic heart disease and low back/neck pain, according to the most recent data.

OHCA is a leading cause of global mortality. Approximately 356,500 people are treated for OHCA annually in the U.S.

Coronary artery disease is the predominant cause. Overall prognosis and neurological outcome are relatively poor following OHCAs and have remained almost static for the past three decades.

Previous studies on sex differences in OHCAs had limited scope and yielded conflicting results. In a recent study, led by cardiologist Dr. Hanno Tan at the University of Amsterdam in the Netherlands, researchers aimed to provide a comprehensive overall view on sex differences in care utilization and outcome of OHCA.

The researchers performed a population-based cohort study, analyzing all resuscitation attempts made by emergency medical services (EMS) in one province of the Netherlands (2006–2012). They calculated odds ratios (ORs) for the association of sex and chance of a resuscitation attempt by EMS, shockable initial rhythm (SIR), and in-hospital treatment using logistic regression analysis.

They identified 5717 OHCAs treated during this period, 28% of which occurred in women. Women were less likely than men to receive a resuscitation attempt by a bystander (68% versus 73%), even when there was someone there to witness the collapse (69% versus 74%).

Survival from the time of the cardiac arrest to admission to hospital was lower in women (34% versus 37%), and women were less likely to survive from admission to discharge (37% versus 55%). The chances of women surviving to be discharged from hospital was about half that of men (12.5% versus 20%).

According to Tan, people may be less aware that cardiac arrest can occur as often in women as in men, and the women themselves may not recognize the urgency of their impending heart attack symptoms, such as fatigue, fainting, vomiting and neck or jaw pain, whereas men are more likely to report typical complaints such as chest pain.

Tackling the problem of survival differences between men and women might include public awareness campaigns about heart attack and cardiac arrest in women and changes in health care systems to facilitate faster resuscitation to women, including wearing devices to monitor heart rate and circulation for women who live on their own.