ReviewAssociation between sex and mortality in adults with in-hospital and out-of-hospital cardiac arrest: A systematic review and meta-analysis
Introduction
query>Cardiac arrest (CA), a leading cause of death worldwide, claims the lives of an over 300,000 Americans annually.1, 2 Despite advances in resuscitative and post-resuscitative care, rates of survival and favorable neurologic outcomes remain low for in-hospital cardiac arrest (IHCA), and even lower for out-of-hospital cardiac arrest (OHCA).1 While data exists regarding sex-related disparities in outcomes following IHCA3, 4, 5, 6, 7, 8, 9 and OHCA,10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 these studies have yielded conflicting results. A recent meta-analysis of 13 observational studies of patients with sudden cardiac arrest reported higher survival to hospital discharge in women compared to men,24 however, multiple studies involving patients less than 18 years of age were included in the quantitative analysis. Furthermore, since publication of this meta-analysis, several subsequent observational studies evaluating sex-related differences in outcomes have been published demonstrating contradictory results.10, 11, 12, 13, 14, 15, 16, 17, 18 Accordingly, we conducted a systematic review and meta-analysis of studies to specifically investigate the association between sex and mortality in adults with IHCA and OHCA.
Section snippets
Methods
We report this systematic review in accordance with the Preferred Reporting of Items for Systematic Reviews And Meta-Analyses (PRISMA) statement.25
Systematic search
Database search yielded 9916 citations. A total of 9833 citations were excluded given the titles and/or abstracts were not relevant to the proposed review. The remaining 83 articles were examined in greater detail for relevance. Eleven of these citations were excluded due to absence of data on sex-specific in-hospital or 30-day mortality. Another 51 citations were excluded as these were either case reports, review articles or involved inappropriate study populations. Overall, there were 21
Discussion
The principal findings of this systematic review and meta-analysis of observational clinical studies of adult patients with cardiac arrest are that female sex was associated with over 50% higher mortality following OHCA and a trend toward higher mortality following IHCA compared to male sex. To our knowledge, this is the first meta-analysis to examine sex-related disparities in outcomes in the setting of IHCA and the largest meta-analysis to date to examine outcomes in the setting of OHCA.
The
Conclusions
In adults with cardiac arrest, female sex was associated with over 50% higher mortality following OHCA compared to male sex and a trend toward higher mortality following IHCA. Further large-scale studies examining sex-related disparities in clinical presentation, management, and clinical outcomes in adults with OHCA and IHCA are warranted.
Funding support
Stony Brook Department of Medicine.
Conflict of interest statement
None.
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A more conservative test of sex differences in the treatment and outcome of in-hospital cardiac arrest
2023, Heart and LungCitation Excerpt :Regarding sudden cardiac arrest (CA), research has clearly shown that racial minorities and individuals with lower socioeconomic status (SES), such as uneducated and poor people, receive inferior treatment and are less likely to survive a sudden cardiac arrest both outside (of-hospital cardiac arrest=OHCA) and inside (in-hospital cardiac arrest=IHCA) the hospital.1-7 Regarding sex disparities, individual studies have produced rather divergent findings,8-10 although recent meta-analyses11,12 suggest that men show a survival advantage after OHCA compared to women, particularly when it comes to survival to discharge and to 30 days. Various empirically supported explanations have been provided for this disparity.
Women Are Less Likely to Survive AMI Presenting With Out-of-Hospital Cardiac Arrest: A Nationwide Study
2022, Mayo Clinic ProceedingsCitation Excerpt :Several studies report that sex is not an independent predictor of mortality in OHCA patients.23-27 In contrast, the studies that reported higher risk of death in women attributed it to the differences in patients’ characteristics, prehospital management, and inpatient management.14-20 In one study, women presenting with OHCA were older, had lower rates of shockable rhythm,14 and experienced disparities in the prehospital management of OHCA.
Even When the Heart Stops, the Sex Differences Remain
2022, Mayo Clinic ProceedingsSex-related disparities in the in-hospital management of patients with out-of-hospital cardiac arrest
2022, ResuscitationCitation Excerpt :Women experiencing cardiac arrest are less likely to receive bystander cardiopulmonary resuscitation (CPR)5,12–14 and less frequently present with a shockable rhythm.15,16 Conflicting results regarding sex disparities in survival and prognosis after OHCA were noted.16–28 However, the extent of sex disparities in OHCA remains unclear.
Ethnic and sex-based differences in outcomes after out-of-hospital cardiac arrest: a glimpse of the largest municipal healthcare system in the United States
2023, Cardiovascular Diagnosis and Therapy