Out-of-hospital cardiac arrest in women and men Risk factors, short-term survival, and long-term outcomes

Large sex differences exist in incidence and survival chances of out-of-hospital cardiac arrest (OHCA). Survival rates have increased in recent decades, but it is unclear whether both sexes have benefitted equally. Besides biology, sociocultural factors or improvements in pre-hospital and in-hospital care may contribute to sex differences. Pre-hospital care involves timely start of cardiopulmonary resuscitation, but also guidelines for termination of resuscitation. Further, the rising number of OHCA survivors requires attention for the long-term socioeconomic and mental health changes post-OHCA. Understanding OHCA’s impact on long-term survival can aid design of targeted interventions for women and men. This thesis aimed to assess the OHCA burden in women and men, focusing on the association of sociocultural factors with incidence, and sex differences in short-term survival, and long-term outcomes.
Our studies confirmed differences between women and men. For instance, sociocultural characteristics were associated with OHCA incidence, especially among women. Moreover, the short-term survival rates increased for men over time, while remaining unchanged in women. This was associated with differences in proportions of shockable initial rhythm and in-hospital interventions. However, guidelines for termination of resuscitation were equally applicable in both sexes. In the long-term, employment rates and income decreased in women and men, mirroring general population trends, while dispensing of anxiety/depression medication increased disproportionately in women. Long-term survival rates post-OHCA did not differ by sex, but factors associated with survival were sex-specific.
Our work may provide targets for prevention and treatment strategies to mitigate sex disparities in OHCA incidence, survival and long-term outcomes.