Acute cardiac care & resuscitation

Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis

EuropacePublished Population-based cohort study

Authors' conclusion

Women have a lower crude 30-day survival following OHCA compared to men. The poor prognosis is largely explained by a lower proportion of shockable initial rhythm, older age at presentation, and lower income.

Study context

Population
EMS-treated Out-of-hospital Cardiac Arrest (OHCA) reported to the Swedish Registry for Cardiopulmonary Resuscitation, 2010–2020
Participants
43,226 OHCAs
Exposure
Women vs men
  • Womenn = 14,249
Outcome
Survival
Follow-up
30 days
Methodological detailsnationwide registry linkage, mediation analysis
  • Nationwide registry linkage
  • Mediation analysis

Main finding

As reported in the abstract

Crude 30-day survival
Women vs MenRelative risk (95% CI)
Crude
0.58(0.54–0.62)
Adjusted for shockable initial rhythm
0.85(0.79–0.91)
Further adjusted for age and resuscitation factors
0.98(0.92–1.05)

Observational data: associations, not effects.

Further findings

Mediation of sex difference in survival

Shockable initial rhythm explained share of negative association of female sex on survival
∼50%
Older age and lower disposable income the second and third most important variables

Original publication

Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis. Europace. Published 14 May 2024. doi:10.1093/europace/euae126

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