Sex differences in outcome following community-based cardiopulmonary arrest

Aims: To determine whether men and women suffering cardiopulmonary arrest differ in terms of survival and risk factors for survival.

Methods and results: A prospective cohort study, using the Heartstart (Scotland) database, was undertaken on all 22 161 people suffering community-based cardiopulmonary arrest in Scotland between 1988 and 1997. The outcomes studied were death at the arrest scene, death before admission, death in hospital and death at any point up to discharge. Univariate analysis, using chi-square and Mann-Whitney U tests, was used to compare men and women in terms of patient characteristics, management and outcome. Multivariate logistic regression analysis was used to determine the association between sex and outcome after adjustment for case-mix. Sex differences in outcome varied over time. Women had a poorer risk profile than men. They were older (P<0.0001) and less likely to have shockable rhythms (P<0.0001). Despite this, they were more likely to survive to admission (P<0.0001). However, thereafter, women were more likely to die in hospital (P<0.01). There was no significant difference between the sexes in overall case-fatality rates to discharge.

Conclusion: Women have a better early prognosis than men. However, this represents a postponement of death, rather than avoidance.