Skip to main content

Sex-specific differences and outcome in elderly patients after survived out-of-hospital cardiac arrest

Geschlechtsspezifische Unterschiede und Outcome bei älteren Patienten nach überlebtem präklinischem Herzstillstand

Abstract

Background

Little is known about sex differences in elderly patients after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) and subsequent target temperature management (TTM). Therefore, this study was designed to evaluate sex-specific differences in survival and neurological outcome in elderly patients at 28-day and 180-day follow-up.

Methods

A total of 468 nontraumatic OHCA survivors with preclinical ROSC and an age of ≥ 65 years were included in this study. Sex-specific differences in survival and a favorable neurological outcome according to the cerebral performance category (CPC) score were evaluated as clinical endpoints.

Results

Of all participants included, 70.7% were men and 29.3% women. Women were significantly older (p = 0.011) and were more likely to have a nonshockable rhythm (p = 0.001) than men. Evaluation of survival rate and favorable neurological outcome by sex category showed no significant differences at 28-day and 180-day follow-up. In multiple stepwise logistic regression analysis, age (odds ratio 0.932 [95% confidence interval 0.891–0.951], p = 0.002) and time of hypoxia (0.899 [0.850–0.951], p < 0.001) proved to be independent predictors of survival only in male patients, whereas an initial shockable rhythm (4.325 [1.309–14.291], p = 0.016) was associated with 180-day survival in female patients. The majority of patients (93.7%) remained in the same CPC category when comparing 28-day and 180-day follow-up.

Conclusion

Our results show no significant sex-specific differences in survival or favorable neurological outcome in elderly patients after having survived OHCA, but sex-specific predictors for 180-day survival. Moreover, the neurological assessment 28 days after the index event also seems to provide a valid indication for the further prognosis in elderly patients.

Zusammenfassung

Hintergrund

Aktuell existieren nur wenige Daten über geschlechtsspezifische Unterschiede bei älteren Patienten mit überlebtem außerklinischem Herz-Kreislauf-Stillstand (OHCA) und anschließendem Temperaturmanagement (TTM). Daher wurden geschlechtsspezifische Unterschiede im Überleben und im neurologischen Ergebnis bei älteren Patienten nach 28 und 180 Tagen untersucht.

Material und Methoden

Insgesamt wurden 468 Patienten ≥ 65 Jahren mit OHCA sowie präklinischer Rückkehr eines Spontankreislaufs (ROSC) berücksichtigt. Evaluiert wurden die Überlebenswahrscheinlichkeit und der neurologischer Status gemessen mittels Cerebral-Performance-Category(CPC)-Skala.

Ergebnisse

Frauen (29,3 % des Studienkollektivs) waren im Vergleich zu Männern (70,7 %) signifikant älter (p = 0,011) und wiesen häufiger einen nicht schockbaren Rhythmus (p = 0,001) auf. Es wurden kein signifikanter Unterschied beim Überleben und beim neurologischen Outcome festgestellt. In der multiplen Regressionsanalyse wurden bei männlichen Patienten das Alter (Odds-Ratio 0,932 [95 %-Konfidenzintervall 0,891–0,951], p = 0,002) und die Zeit bis zum Beginn der Reanimation (0,899 [0,850–0,951], p < 0,001) als unabhängige Prädiktoren für das Überleben nach 6 Monaten identifiziert. Bei Frauen zeigte nur ein initial schockbarer Rhythmus (4,325 [1,309–14,291], p = 0,016) eine unabhängige Assoziation mit dem Überleben nach 6 Monaten. Die Mehrheit der Patienten (93,7 %) wies keine Änderung des neurologischen Status zwischen den Messzeitpunkten auf.

Diskussion

Die Ergebnisse zeigen bei älteren Patienten bis 6 Monate nach dem Herz-Kreislauf-Stillstand keinen geschlechtsspezifischen Unterschied beim Überleben und beim neurologischen Status, aber geschlechtsspezifische Prädiktoren für das 180-Tage-Überleben. Zudem war eine valide prognostische Aussage bezüglich des neurologischen Status bereits 28 Tage nach dem Indexereignis möglich.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Go AS, Mozaffarian D, Roger VL et al (2013) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127:e6–e245

    PubMed  Google Scholar 

  2. 2.

    Yan S, Gan Y, Jiang N et al (2020) The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care 24:61

    Article  Google Scholar 

  3. 3.

    World Health Organization (2001) Men, Ageing and Health. https://apps.who.int/iris/bitstream/handle/10665/66941/WHO_NMH_NPH_01.2.pdf. Accessed: 01 June 2021

  4. 4.

    Lee PY, Alexander KP, Hammill BG et al (2001) Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 286:708–713

    CAS  Article  Google Scholar 

  5. 5.

    Vitale C, Fini M, Spoletini I et al (2017) Under-representation of elderly and women in clinical trials. Int J Cardiol 232:216–221

    Article  Google Scholar 

  6. 6.

    Morrison LJ, Schmicker RH, Weisfeldt ML et al (2016) Effect of gender on outcome of out of hospital cardiac arrest in the Resuscitation Outcomes Consortium. Resuscitation 100:76–81

    Article  Google Scholar 

  7. 7.

    Hasan OF, Al Suwaidi J, Omer AA et al (2014) The influence of female gender on cardiac arrest outcomes: a systematic review of the literature. Curr Med Res Opin 30:2169–2178

    Article  Google Scholar 

  8. 8.

    Lindner TW, Langørgen J, Sunde K et al (2013) Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU. Crit Care 17:R147

    CAS  Article  Google Scholar 

  9. 9.

    Stub D, Smith K, Bray JE et al (2011) Hospital characteristics are associated with patient outcomes following out-of-hospital cardiac arrest. Heart 97:1489–1494

    Article  Google Scholar 

  10. 10.

    Karlsson V, Dankiewicz J, Nielsen N et al (2015) Association of gender to outcome after out-of-hospital cardiac arrest—a report from the International Cardiac Arrest Registry. Crit Care 19:182

    Article  Google Scholar 

  11. 11.

    Adielsson A, Hollenberg J, Karlsson T et al (2011) Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart 97:1391–1396

    Article  Google Scholar 

  12. 12.

    Herlitz J, Engdahl J, Svensson L et al (2004) Is female sex associated with increased survival after out-of-hospital cardiac arrest? Resuscitation 60:197–203

    Article  Google Scholar 

  13. 13.

    Nielsen N, Wetterslev J, Cronberg T et al (2013) Targeted temperature management at 33 °C versus 36 °C after cardiac arrest. N Engl J Med 369:2197–2206

    CAS  Article  Google Scholar 

  14. 14.

    Pätz T, Stelzig K, Pfeifer R et al (2019) Age-associated outcomes after survived out-of-hospital cardiac arrest and subsequent target temperature management. Acta Anaesthesiol Scand 63:1079–1088

    Article  Google Scholar 

  15. 15.

    Cummins RO, Chamberlain DA, Abramson NS et al (1991) Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 84:960–975

    CAS  Article  Google Scholar 

  16. 16.

    Ajam K, Gold LS, Beck SS et al (2011) Reliability of the Cerebral Performance Category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study. Scand J Trauma Resusc Emerg Med 19:38

    Article  Google Scholar 

  17. 17.

    Topjian AA, Localio AR, Berg RA et al (2010) Women of child-bearing age have better inhospital cardiac arrest survival outcomes than do equal-aged men. Crit Care Med 38:1254–1260

    Article  Google Scholar 

  18. 18.

    Kitamura T, Iwami T, Nichol G et al (2010) Reduction in incidence and fatality of out-of-hospital cardiac arrest in females of the reproductive age. Eur Heart J 31:1365–1372

    Article  Google Scholar 

  19. 19.

    Zhu D, Chung H‑F, Dobson AJ et al (2019) Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health 4:e553–e564

    Article  Google Scholar 

  20. 20.

    Blewer AL, McGovern SK, Schmicker RH et al (2018) Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public. Circ Cardiovasc Qual Outcomes 11:e4710

    Article  Google Scholar 

  21. 21.

    Mumma BE, Umarov T (2016) Sex differences in the prehospital management of out-of-hospital cardiac arrest. Resuscitation 105:161–164

    Article  Google Scholar 

  22. 22.

    Malta Hansen C, Kragholm K, Dupre ME et al (2018) Association of bystander and first-responder efforts and outcomes according to sex: results from the north Carolina heartrescue statewide quality improvement initiative. J Am Heart Assoc 7:e9873

    Article  Google Scholar 

  23. 23.

    Schatzkin A, Cupples LA, Heeren T et al (1984) Sudden death in the Framingham Heart Study: differences in incidence and risk factors by sex and coronary disease status. Epidemiol Rev 120:888–899

    CAS  Google Scholar 

  24. 24.

    Kannel WB, Wilson PW, D’Agostino RB et al (1998) Sudden coronary death in women. Am Heart J 136:205–212

    CAS  Article  Google Scholar 

  25. 25.

    Mader TJ, Westafer LM, Nathanson BH et al (2017) Targeted temperature management effectiveness in the elderly: insights from a large registry. Ther Hypothermia Temp Manag 7:222–230

    Article  Google Scholar 

  26. 26.

    van de Glind EMM, van Munster BC, van de Wetering FT et al (2013) Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review. BMC Geriatr 13:68–68

    Article  Google Scholar 

  27. 27.

    Safdar B, Stolz U, Stiell IG et al (2014) Differential survival for men and women from out-of-hospital cardiac arrest varies by age: results from the OPALS study. Acad Emerg Med 21:1503–1511

    Article  Google Scholar 

  28. 28.

    Bosson N, Kaji AH, Fang A et al (2016) Sex differences in survival from out-of-hospital cardiac arrest in the era of regionalized systems and advanced post-resuscitation care. J Am Heart Assoc 5. https://doi.org/10.1161/JAHA.116.004131

  29. 29.

    Winther-Jensen M, Kjaergaard J, Wanscher M et al (2015) No difference in mortality between men and women after out-of-hospital cardiac arrest. Resuscitation 96:78–84

    Article  Google Scholar 

  30. 30.

    Hiemstra B, Bergman R, Absalom AR (2018) Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Ther Adv Cardiovasc Dis 12:341–349

    Article  Google Scholar 

  31. 31.

    Becker LB, Aufderheide TP, Geocadin RG et al (2011) Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association. Circulation 124:2158–2177

    Article  Google Scholar 

  32. 32.

    Tong JT, Eyngorn I, Mlynash M et al (2016) Functional neurologic outcomes change over the first 6 months after cardiac arrest. Crit Care Med 44:e1202–e1207

    Article  Google Scholar 

  33. 33.

    Sasson C, Rogers MA, Dahl J et al (2010) Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3:63–81

    Article  Google Scholar 

  34. 34.

    Rezar R, Wernly B, Haslinger M et al (2021) Mortality after cardiopulmonary resuscitation on a medical ICU : A sex-specific outcome analysis. Wien Klin Wochenschr 133:492–499

    Article  Google Scholar 

  35. 35.

    Kotini-Shah P, Del Rios M, Khosla S et al (2021) Sex differences in outcomes for out-of-hospital cardiac arrest in the United States. Resuscitation 163:6–13

    Article  Google Scholar 

  36. 36.

    Libungan B, Lindqvist J, Strömsöe A et al (2015) Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study. Resuscitation 94:28–32

    Article  Google Scholar 

  37. 37.

    Phelps R, Dumas F, Maynard C et al (2013) Cerebral Performance Category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med 41:1252–1257

    Article  Google Scholar 

  38. 38.

    Haywood K, Whitehead L, Nadkarni VM et al (2018) COSCA (core outcome set for cardiac arrest) in adults: an advisory statement from the international liaison committee on resuscitation. Circulation 137:e783–e801

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Toni Pätz MD.

Ethics declarations

Conflict of interest

T. Pätz, K. Stelzig, R. Pfeifer, H. Thiele, H.-J. Busch, T. Stiermaier, I. Eitel and S. Wolfrum declare that they have no competing interests.

Anonymized data were transmitted into the registry with approval by the local ethic committees.

Additional information

figureqr

Scan QR code & read article online

Redaktion

Michael Buerke, Siegen

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pätz, T., Stelzig, K., Pfeifer, R. et al. Sex-specific differences and outcome in elderly patients after survived out-of-hospital cardiac arrest. Med Klin Intensivmed Notfmed (2021). https://doi.org/10.1007/s00063-021-00869-2

Download citation

Keywords

  • Resuscitation
  • Intensive care
  • Predictors
  • Neurological outcome
  • Survival

Schlüsselwörter

  • Reanimation
  • Intensivmedizin
  • Prädiktoren
  • Neurologisches Outcome
  • Überleben