Key result
Female sex was associated with a longer post-OHCA survival compared to male sex, with an adjusted incidence rate ratio for mortality of 0.74 in the Danish cohort.
Why the study?
Sex differences in long-term survival after out-of-hospital cardiac arrest compared to the general population, and the influence of comorbidities, social, and resuscitation factors by sex, were not fully defined.
Cohort (n=3,707)
Yes
Relative Risk: 0.74 (95% CI 0.61–0.89)
Following out-of-hospital cardiac arrest, women demonstrated a long-term survival advantage compared to men in Denmark, but both sexes experienced significantly reduced life expectancies relative to the general population, with available clinical and social predictors providing low discriminative power for long-term prognosis.
Women surviving 30-day post-OHCA may have lower long-term mortality than men; this Level 3 association leaves open causal mechanisms and targeted interventions.
AIM: We aimed to study sex differences in long-term survival following out-of-hospital cardiac arrest (OHCA) compared to the general population, and determined associations for comorbidities, social characteristics, and resuscitation characteristics with survival in women and men separately. METHODS: We followed 2,452 Danish (530 women and 1,922 men) and 1,255 Dutch (259 women and 996 men) individuals aged ≥25 years, who survived 30 days post-OHCA in 2009-2015, until 2019. Using Poisson regression analyses we assessed sex differences in long-term survival and sex-specific associations of characteristics mutually adjusted, and compared survival with an age- and sex-matched general population. The potential predictive value was assessed with the Concordance-index. RESULTS: Post-OHCA survival was longer in women than men (adjusted incidence rate ratio (IRR) for mortality 0.74, 95%CI 0.61-0.89 in Denmark; 0.86, 95%CI 0.65-1.15 in the Netherlands). Both sexes had a shorter survival than the general population (e.g., IRR for mortality 3.07, 95%CI 2.55-3.70 and IRR 2.15, 95%CI 1.95-2.37 in Danish women and men). Higher age, glucose lowering medication, no dyslipidaemia medication, unemployment, and a non-shockable initial rhythm were associated with shorter survival in both sexes. Cardiovascular medication, depression/anxiety medication, living alone, low household income, and residential OHCA location were associated with shorter survival in men. Not living with children and bystander cardiopulmonary resuscitation provision were associated with shorter survival in women. The Concordance-indexes ranged from 0.51 to 0.63. CONCLUSIONS: Women survived longer than men post-OHCA. Several characteristics were associated with long-term post-OHCA survival, with some sex-specific characteristics. In both sexes, these characteristics had low predictive potential.
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Smits et al. (2024) conducted a cohort in Out-of-hospital cardiac arrest (OHCA) (n=3,707). Female sex vs. Male sex was evaluated on All-cause mortality (long-term survival from 30 days post-OHCA onwards) (IRR 0.74, 95% CI 0.61-0.89). Female sex was associated with a longer post-OHCA survival compared to male sex, with an adjusted incidence rate ratio for mortality of 0.74 in the Danish cohort.
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