A study in Switzerland has found that women are at a huge disadvantage when it comes to cardiac arrest, being less likely to be admitted to an ICU, receiving less intensive care treatment, and having a higher risk of dying than men.
Cardiac arrest is one of the most common causes of death worldwide, despite advances in modern medicine. But data indicate that women often have poorer chances of survival after a cardiac arrest and a lower quality of life than men.
The reasons for this are manifold and, in addition to biological differences, could also be attributed to less frequent or delayed resuscitation measures in women, reports MyScience.
Gender-specific differences in the intensity of treatment before and after admission to the intensive care unit and in the decision on life-prolonging measures are also considered to be the cause of unequal chances of survival.
However, there is hardly any research data on these gender-specific differences for Western Europe to date.
Swiss-wide study with 40 000 patients
Under the leadership of intensive care physician PD Dr Caroline Gebhard, Dr Simon Amacher and other researchers from the University Hospital Basel and the University of Baselinvestigated the gender-specific differences in the treatment of 41 733 patients with cardiac arrest throughout Switzerland between 2008 and 2022. Of these, 21 692 patients were admitted to and treated in Swiss intensive care units.
The researchers recorded temporal trends in ICU mortality, trends in ICU admission probability, the use of intensive care therapy measures and treatment limitations in patients who survived a cardiac arrest in the short term.
Women receive less intensive care
The findings show that women are 18% less likely to be admitted to an ICU than men. Invasive treatments such as catheter-guided cardiac examinations were also performed less frequently in women than in men (44.7% compared witho 54% invasive therapies in men).
Overall, women who survived a cardiac arrest were at a higher risk of subsequent death than men (41.8% versus 36.2% mortality rate in men).
The researchers suspect various reasons for this unequal treatment of patients who have survived a cardiac arrest. These include biological differences, socio-cultural factors and unconscious thought patterns that favour men.
The study, published in Critical Care, also highlights the urgent need to gather more detailed information on socio-cultural factors to better investigate the causes of gender differences in the treatment of these patients.
Study details
Sex disparities in ICU care and outcomes after cardiac arrest: a Swiss nationwide analysis
Simon A. Amacher, Tobias Zimmermann, Pimrapat Gebert et al.
Published in Critical Care on 23 January 2025
Abstract
Background
Conflicting data exist regarding sex-specific outcomes after cardiac arrest. This study investigates sex disparities in the provision of critical care and outcomes of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.
Methods
Analysis of adult cardiac arrest patients admitted to certified Swiss intensive care units (ICUs) (01/2008–12/2022) using the nationwide prospective ICU registry. The primary outcome was ICU mortality, with secondary outcomes including ICU admission probability and advanced treatment provision.
Results
Among 41 733 individuals (34.9% women), 21 692 patients (30.6% women) were admitted to ICUs (16,571 OHCA patients/5121 IHCA patients). Women were less likely to be admitted to the ICU than men (incidence rate ratio 0.82 [95% CI 0.80–0.85] and had a higher ICU mortality (41.8% vs 36.2%; p < 0.001). Mortality differences were more pronounced in OHCA patients (unadjusted HR: 1.35 [95% CI 1.28–1.43]; adjusted HR: 1.19 [95% CI 1.12–1.25]). In IHCA patients, mortality differences were less pronounced (unadjusted HR: 1.14 [95% CI 1.04–1.25]) and vanished after adjustment for confounders: adjusted HR: 1.03 [95% CI 0.94–1.13]). Women after cardiac arrest were older, more severely ill, and received fewer interventions before (44.7% vs 54.0%; p < 0.001) and during ICU stay. A subgroup analysis of 11 202 patients revealed that treatment limitations were more frequent in women (46.7% vs 38.7%; p < 0.001). However, these limitations were associated with an increased risk of death in both sexes.
Conclusions
This study highlights sex disparities in short-term mortality and ICU resource allocation among cardiac arrest patients, with women potentially facing disadvantages, in particular after OHCA. The limitations of ICU registry data, particularly the lack of detailed cardiac arrest-specific and comorbidity information, restrict definitive conclusions. Future research should prioritise prospective studies with more granular data to better understand and address these disparities.
MyScience article – Women at a disadvantage after cardiac arrest (Open access)
See more from MedicalBrief archives:
Physician bias behind women getting worse heart attack treatment — 43-hospital study
Women more likely to survive heart attack if treated by female doctor
Work and social stress put women at significantly higher heart risk