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Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018

Mateo-Rodríguez I, Knox EC, Ruiz-Azpiazu JI, Fernández del Valle P, Daponte-Codina A, Jiménez-Fábrega X, Navalpotro-Pascual JM, Iglesias-Vázquez JA, Echarri-Sucunza A, Alonso-Moreno D, Forner-Canos AB, García-Ochoa Blanco MJ, Del Pozo-Pérez C, Mainar-Gómez B, Batres-Gómez S, Cortés-Ramas JA, Ceniceros-Rozalén MI, Guirao-Salinas FA, Fernández-Martínez B, Mora MA, Carriedo-Scher C, Bragado-Blas ML, Mellado-Vergel FJ, Rosell-Ortiz F

Escuela Andaluza de Salud P√ļblica, Granada, Spain. CIBER de Epidemiolog√≠a y Salud P√ļblica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. Universidad Nacional de Educaci√≥n a Distancia (UNED), Madrid, Spain. Servicio de Urgencias M√©dica 061, La Rioja, Spain. Fundaci√≥n para la Formaci√≥n e Investigaci√≥n, Extremadura, Spain. Sistema de Emergencies Mediques, Catalunya, Espa√Īa. SUMMA112, Madrid, Spain. Fundaci√≥n P√ļblica Urxencias Sanitarias 061, Galicia, Spain. Servicios de Urgencias Extrahospitalarias de Navarra, Spain. Emergentziak-Emergencias, Osakidetza, Euzkadi, Spain. SAMU, Emergencias Sanitarias, Comunidad Valenciana, Spain. SAMUR Protecci√≥n Civil, Spain. Emergencias Sanitarias, Castilla y Le√≥n, Spain. Instituto de Ciencias de la Salud, Arag√≥n, Spain. Emergencias Sanitarias de Extremadura, Spain. Servicio de Bomberos de Zaragoza, Arag√≥n, Spain. SAMU 061 Baleares, Spain. Servicio de Emergencias 061, Murcia, Spain. Servicio de Emergencia 061 Cantabria, Spain. Servicio de Urgencias y Emergencias, Castilla La Mancha, Spain. Servicio de Urgencias del Hospital El Toyo, Almer√≠a, Spain..

Objective. To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series.
Methods. Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time.
Results. Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P < .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P < .001 in both series).
Conclusions. The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.

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