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Women less likely to receive basic life support for cardiac arrest from public

Women are less likely to receive basic life support for cardiac arrest from members of the public then men, the European Society of Cardiology announced today on International Women’s Day.

“There is a misconception that women don’t have heart problems so they don’t get as much help from the public and they are not treated the same by doctors,” said Dr Nicole Karam, an interventional cardiologist at the European Hospital Georges Pompidou in Paris, France.

The study included all 11 420 patients who had an out-of-hospital cardiac arrest in Paris and the surrounding suburbs between 2011 and 2014. Data on how the patients were treated were recorded in a prospective registry at the Sudden Death Expertise Centre (SDEC).

The researchers found that 40% of the sudden cardiac arrests occurred in women. Bystanders were more often present when cardiac arrests occurred in women than when they occurred in men, but only 60% of women received basic life support, including cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED), compared to 70% of men.

“When a man has a cardiac arrest he is less likely to have witnesses but they perform CPR more frequently,” said Dr Karam. “Probably people are more afraid to do CPR in women because we look fragile. They may also not believe that she is really having a cardiac arrest – even though we found that 40% of patients were women.”

The researchers found that 18% of women made it to the hospital alive compared to 26% of men. Dr Karam said: “Here we cannot blame the victim herself because a cardiac arrest by definition happens suddenly. Patients collapse, lose consciousness, and cannot help themselves. Bystanders often fail to help women probably because they don’t believe it’s a cardiac arrest and the medical services are less likely to rush them to the catheterisation laboratories for an angiogram. Besides, extracorporeal life support, another key factor in sudden cardiac arrest management, is six times less frequently performed in women than in men.”

ESC guidelines recommend that unless there is another obvious cause for cardiac arrest (gunshot wound, for example) all patients should receive an angiogram to check for coronary artery disease, regardless of their gender. But the study found that of those who did reach the hospital alive, just 40% of women had an angiogram compared to 60% of men. Of those women who did have any angiogram, almost half had a coronary artery disease.

“Our study shows that women receive less investigations and treatment than men, despite the guidelines saying that they should be dealt with the same,” said Dr Karam. “There is still a mistaken belief that women do not get coronary artery disease. But we found that coronary artery disease was the cause of sudden cardiac arrest in one-third of the women who did have an angiogram. So the angiograms were not a waste of time.”

She added: “A previous study in our hospital showed that cardiac arrest victims often had symptoms on the previous day, including fainting, blackouts, dizziness, palpitations, chest pain and shortness of breath. Women have a tendency to think they are imagining their pain or symptoms, or decide to deal with them later. But women need to listen to their bodies if they have chest pain, go to the doctor and be quick.”

Dr Karam concluded: “The frequency of coronary artery disease in women is increasing so it’s no longer a ‘man’s problem’. Cardiac arrest is not a rare event in women – in our study four in every ten arrests occurred in women. When it does happen, doctors need to manage women just as they would manage men. We can only improve women’s survival from cardiac arrest when doctors, emergency medical services, the public, and women themselves accept that it can happen to anyone regardless of gender.”