Journal of Interventional Cardiac Electrophysiology

, Volume 34, Issue 3, pp 219–225

Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death Study

Authors

  • Carmen Teodorescu
    • The Heart InstituteCedars-Sinai Medical Center
  • Kyndaron Reinier
    • The Heart InstituteCedars-Sinai Medical Center
  • Audrey Uy-Evanado
    • The Heart InstituteCedars-Sinai Medical Center
  • Jo Ayala
    • The Heart InstituteCedars-Sinai Medical Center
  • Ronald Mariani
    • The Heart InstituteCedars-Sinai Medical Center
  • Lynn Wittwer
    • PeaceHealth Southwest Medical Center and Clark County EMS
  • Karen Gunson
    • Department of PathologyOregon Health and Science University
  • Jonathan Jui
    • Emergency MedicineOregon Health and Science University
    • The Heart InstituteCedars-Sinai Medical Center
Article

DOI: 10.1007/s10840-012-9669-2

Cite this article as:
Teodorescu, C., Reinier, K., Uy-Evanado, A. et al. J Interv Card Electrophysiol (2012) 34: 219. doi:10.1007/s10840-012-9669-2

Abstract

Objective

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.

Methods

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.

Results

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)].

Conclusions

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.

Keywords

Sudden cardiac arrestSurvivalWomenPulseless electrical activityVentricular fibrillationResuscitation

Copyright information

© Springer Science+Business Media, LLC 2012