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A 5-year research project outlines some of the reasons why women are less likely to survive cardiac arrest than men. Image credit: Spencer Platt/Getty Images.
  • Every year, about 6 million people globally die from sudden cardiac death caused by sudden cardiac arrest (SCA).
  • Scientists have been conducting SCA-related research through the ESCAPE-NET project for the past 5 years.
  • Project research found primary care visits rose sharply in the weeks before a person experiences SCA.
  • Another study found that emergency medical services (EMS) professionals provide less rapid resuscitation care to women than men, leading to a lower survival rate from SCA.

Each year, about 6 million people around the world die from sudden cardiac death caused by sudden cardiac arrest (SCA).

For the past 5 years, researchers from the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC), and the European Resuscitation Council (ERC) worked to improve SCA prevention and treatment through the ESCAPE-NET project, which concluded on January 1, 2023.

During this time, more than 100 studies connected to ESCAPE-NET research have been published in peer-reviewed journals.

One study published in the Journal of the American Heart Association in December 2021 found that primary care visits rose sharply the weeks before a person experiences SCA.

And another study, published in the European Heart Journal in May 2019, found that women receive less rapid resuscitation care from bystanders noticing they are having cardiac arrest than men, leading to a lower survival rate for women from SCA.

SCA occurs when an abnormal heart rhythm called an arrhythmia causes the heart’s electrical system to stop working properly. This causes the heart to unexpectedly stop beating.

SCA is different from a heart attack, where a coronary artery becomes blocked and blood is not able to reach the heart. However, a heart attack can cause SCA and puts a person at higher risk for SCA.

Symptoms of SCA include:

Because SCA occurs so quickly, the first treatment for SCA is normally calling emergency medical services and administering cardiopulmonary resuscitation (CPR) until help arrives.

Previous research shows that how quickly a person administers CPR has a direct effect on the survival rate and neurologic outcomes of the person with SCA.

In the study from the Journal of the American Heart Association, ESCAPE-NET researchers found that people who experienced out-of-hospital cardiac arrest (OHCA) were more likely to have visited their primary care doctor in the weeks before having the cardiac arrest incident.

Scientists evaluated data from almost 29,000 patients from the Danish Cardiac Arrest Registry who had OHCA. Upon analysis, researchers found the weekly percentages of patients meeting with their general care practitioner the year before the OHCA were constant.

However, 1 week before the OCHA, 42% of patients contacted their doctor. The research team also found that 2 weeks before experiencing an OHCA, 57.8% of patients contacted their doctor.

“Contrary to the general assumption, sudden cardiac arrest does not strike entirely unheralded, as ESCAPE-NET data have shown that patients attend primary care more often in the run-up to an arrest compared to usual,” explains Dr. Han Tan, ESCAPE-NET project leader, and cardiologist at the Amsterdam University Medical Centre AMC in the Netherlands.

“This insight may provide a lead for efforts to identify individuals at imminent risk of sudden cardiac arrest so that it can be prevented,” adds Dr. Tan.

Medical News Today also spoke with Dr. Alexandra Lajoie, a noninvasive cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, about this study.

“I hope this research educates both patients and primary providers because the fact that they’re going and seeking care before the cardiac arrest, that’s really unfortunate because somebody saw them and still didn’t prevent this from happening,” she said.

“I think the majority of cardiac arrests are avoidable if the underlying cause is treated quickly prior to the arrest,” Dr. Lajoie continued. “I think that this shows that both patients and primary care providers need to take certain symptoms more seriously, be that chest pain, palpitations, lightheadedness, fainting, [or] shortness of breath.”

And Dr. Lajoie said these findings may also be due to limited access to care. “Patients may see their primary care doctor who is concerned about these symptoms appropriately and refers them to cardiology, but they can’t see a cardiologist or can’t have their echocardiogram or stress test due to limited access to care,” she detailed.

The ESCAPE-NET study published in the European Heart Journal found that women experiencing an OHCA have a lower chance of being resuscitated compared to men.

Researchers analyzed all emergency medical service (EMS) treated resuscitation attempts in one province of the Netherlands.

When looking at the data, scientists discovered women with OHCA were less likely than men to receive a resuscitation attempt by a bystander, even when it was obvious they were experiencing cardiac arrest.

Researchers also found women with OCHA who were resuscitated had lower odds of overall survival than men.

“This eye-opener must lead to public awareness campaigns aimed at narrowing the gender gap in sudden cardiac arrest management,” Dr. Tan says.

“A lot of that’s attributed to people being concerned about respect for female anatomy or just gender concerns,” Dr. Lajoie adds. “Someone who’s not well-trained may be concerned about doing deeper chest compressions on women who tend to have a smaller chest. And for effective CPR, you do need to give a good 2-inch deep chest compression.”

Dr. Lajoie also mentioned that while there are no known gender-based reasons why women might be at a higher risk for cardiac arrest, they are also more likely to delay going to get care initially with symptoms:

“[With] cardiac arrest, a lot of people think of it as something that comes out of the blue with no warning, which, unfortunately, sometimes that is the case. But oftentimes, patients do have symptoms leading up. Women are known to delay seeking care longer than men with symptoms, so [they are] less likely to get that care when they’re starting to have cardiac symptoms. And so, therefore, more likely to have the massive myocardial infarction that causes cardiac arrest.”

“And there still is this myth out there that men are more likely to have cardiac arrest and heart disease, and so a lot of women don’t recognize that, unfortunately,” Dr. Lajoie added.