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

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

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References

  1. Chugh, S. S., Reinier, K., Teodorescu, C., Evanado, A., Kehr, E., Al Samara, M., et al. (2008). Epidemiology of sudden cardiac death: Clinical and research implications. Progress in Cardiovascular Diseases, 51, 213–228.

    Article  PubMed  Google Scholar 

  2. Nichol, G., Thomas, E., Callaway, C. W., Hedges, J., Powell, J. L., Aufderheide, T. P., et al. (2008). Regional variation in out-of-hospital cardiac arrest incidence and outcome. Jama, 300, 1423–1431.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  4. Rea, T. D., Cook, A. J., Stiell, I. G., Powell, J., Bigham, B., Callaway, C. W., et al. (2010). Predicting survival after out-of-hospital cardiac arrest: Role of the Utstein data elements. Annals of Emergency Medicine, 55, 249–257.

    Article  PubMed  Google Scholar 

  5. Kette, F., & Pellis, T. (2007). Increased survival despite a reduction in out-of-hospital ventricular fibrillation in north-east Italy. Resuscitation, 72, 52–58.

    Article  PubMed  Google Scholar 

  6. Steinmetz, J., Barnung, S., Nielsen, S. L., Risom, M., & Rasmussen, L. S. (2008). Improved survival after an out-of-hospital cardiac arrest using new guidelines. Acta Anaesthesiologica Scandinavica, 52, 908–913.

    Article  PubMed  CAS  Google Scholar 

  7. Garza, A. G., Gratton, M. C., Salomone, J. A., Lindholm, D., McElroy, J., & Archer, R. (2009). Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest. Circulation, 119, 2597–2605.

    Article  PubMed  Google Scholar 

  8. Herlitz, J., Rundqvist, S., Bang, A., Aune, S., Lundstrom, G., Ekstrom, L., et al. (2001). Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest? Resuscitation, 49, 15–23.

    Article  PubMed  CAS  Google Scholar 

  9. Herlitz, J., Engdahl, J., Svensson, L., Young, M., Angquist, K. A., & Holmberg, S. (2004). Is female sex associated with increased survival after out-of-hospital cardiac arrest? Resuscitation, 60, 197–203.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  11. Kim, C., Fahrenbruch, C. E., Cobb, L. A., & Eisenberg, M. S. (2001). Out-of-hospital cardiac arrest in men and women. Circulation, 104, 2699–2703.

    Article  PubMed  CAS  Google Scholar 

  12. Perers, E., Abrahamsson, P., Bang, A., Engdahl, J., Lindqvist, J., Karlson, B. W., et al. (1999). There is a difference in characteristics and outcome between women and men who suffer out of hospital cardiac arrest. Resuscitation, 40, 133–140.

    Article  PubMed  CAS  Google Scholar 

  13. Vukmir, R. B. (2003). Prehospital cardiac arrest and the adverse effect of male gender, but not age, on outcome. Journal of Women’s Health, 12, 667–673.

    Article  PubMed  Google Scholar 

  14. Becker, L. B., Han, B. H., Meyer, P. M., Wright, F. A., Rhodes, K. V., Smith, D. W., et al. (1993). Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. The New England Journal of Medicine, 329, 600–606.

    Article  PubMed  CAS  Google Scholar 

  15. Cowie, M. R., Fahrenbruch, C. E., Cobb, L. A., & Hallstrom, A. P. (1993). Out-of-hospital cardiac arrest: Racial differences in outcome in Seattle. American Journal of Public Health, 83, 955–959.

    Article  PubMed  CAS  Google Scholar 

  16. Chu, K., Swor, R., Jackson, R., Domeier, R., Sadler, E., Basse, E., et al. (1998). Race and survival after out-of-hospital cardiac arrest in a suburban community. Annals of Emergency Medicine, 31, 478–482.

    Article  PubMed  CAS  Google Scholar 

  17. Galea, S., Blaney, S., Nandi, A., Silverman, R., Vlahov, D., Foltin, G., et al. (2007). Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. American Journal of Epidemiology, 166, 534–543.

    Article  PubMed  CAS  Google Scholar 

  18. Reinier, K., Stecker, E. C., Vickers, C., Gunson, K., Jui, J., & Chugh, S. S. (2006). Incidence of sudden cardiac arrest is higher in areas of low socioeconomic status: A prospective two year study in a large United States community. Resuscitation, 70, 186–192.

    Article  PubMed  Google Scholar 

  19. Reinier, K., Thomas, E., Andrusiek, D. L., Aufderheide, T. P., Brooks, S. C., Callaway, C. W., et al. (2011). Socioeconomic status and incidence of sudden cardiac arrest. Cmaj, 183, 1705–1712.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  24. Teodorescu, C., Reinier, K., Dervan, C., Uy-Evanado, A., Samara, M., Mariani, R., et al. (2010). Factors associated with pulseless electric activity versus ventricular fibrillation: The Oregon Sudden Unexpected Death Study. Circulation, 122, 2116–2122.

    Article  PubMed  Google Scholar 

  25. Sudden cardiac death (1985). Report of a WHO Scientific Group. World Health Organization Technical Report Series 726:5–25.

  26. Kitamura, T., Iwami, T., Nichol, G., Nishiuchi, T., Hayashi, Y., Nishiyama, C., et al. (2010). Reduction in incidence and fatality of out-of-hospital cardiac arrest in females of the reproductive age. European Heart Journal, 31, 1365–1372.

    Article  PubMed  Google Scholar 

  27. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383.

    Article  PubMed  CAS  Google Scholar 

  28. Albert, C. M., McGovern, B. A., Newell, J. B., & Ruskin, J. N. (1996). Sex differences in cardiac arrest survivors. Circulation, 93, 1170–1176.

    Article  PubMed  CAS  Google Scholar 

  29. Arking, D. E., Reinier, K., Post, W., Jui, J., Hilton, G., O’Connor, A., et al. (2010). Genome-wide association study identifies GPC5 as a novel genetic locus protective against sudden cardiac arrest. PloS One, 5, e9879.

    Article  PubMed  Google Scholar 

  30. Sayegh, A. J., Swor, R., Chu, K. H., Jackson, R., Gitlin, J., Domeier, R. M., et al. (1999). Does race or socioeconomic status predict adverse outcome after out of hospital cardiac arrest: A multi-center study. Resuscitation, 40, 141–146.

    Article  PubMed  CAS  Google Scholar 

  31. Engdahl, J., Bang, A., Lindqvist, J., & Herlitz, J. (2001). Factors affecting short- and long-term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity. Resuscitation, 51, 17–25.

    Article  PubMed  CAS  Google Scholar 

  32. Kuisma, M., & Maatta, T. (1996). Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting. Heart (British Cardiac Society), 76, 18–23.

    Article  CAS  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.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

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.

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Authors and Affiliations

  1. The Heart Institute, Cedars-Sinai Medical Center, Saperstein Plaza Suite 2S46, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA

    Carmen Teodorescu, Kyndaron Reinier, Audrey Uy-Evanado, Jo Ayala, Ronald Mariani & Sumeet S. Chugh

  2. PeaceHealth Southwest Medical Center and Clark County EMS, Vancouver, WA, USA

    Lynn Wittwer

  3. Department of Pathology, Oregon Health and Science University, Portland, OR, USA

    Karen Gunson

  4. Emergency Medicine, Oregon Health and Science University, Portland, OR, USA

    Jonathan Jui

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  1. Carmen Teodorescu
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  2. Kyndaron Reinier
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  9. Sumeet S. Chugh
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Correspondence to Sumeet S. Chugh.

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Teodorescu, C., Reinier, K., Uy-Evanado, A. et al. Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death Study. J Interv Card Electrophysiol 34, 219–225 (2012). https://doi.org/10.1007/s10840-012-9669-2

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  • DOI: https://doi.org/10.1007/s10840-012-9669-2

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