Wittwer Melanie R, Aldridge Emily, Hein Cindy, Thorrowgood Mel, Zeitz Chris, Beltrame John F, Arstall Margaret A
Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
Northern Adelaide Local Health Network, Adelaide, SA, Australia.
Front Cardiovasc Med. 2022 Apr 8;9:870696. doi: 10.3389/fcvm.2022.870696. eCollection 2022.
Sex and gender differences in presentation and characteristics of out-of-hospital cardiac arrest (OHCA) are established in cohorts with presumed cardiac aetiology but not non-cardiac etiology. This study investigated the effect of sex on incidence and outcome of OHCA according to presumed and adjudicated aetiology within a local health network.
Population-based observational cohort study of emergency medical services (EMS) attended OHCAs within an Australian local health network. Cases identified from an EMS registry between 2012-2016 were linked to a hospital registry. Age-standardised incidence and baseline characteristics were stratified by sex for EMS-treated OHCA, non-EMS witnessed presumed cardiac and obvious non-cardiac sub-cohorts, and hospitalised cases. Logistic regression was used to explore the primary outcome of survival to hospital discharge.
We identified 2,024 EMS-attended and 780 EMS-treated OHCAs. The non-EMS witnessed sub-cohorts comprised 504 presumed cardiac and 168 obvious non-cardiac OHCAs. Adjudicated aetiology was recorded in 123 hospitalised cases. Age-standardised incidence for women was almost half that of men across all groups. Across cohorts, women were generally older and arrested with a non-shockable initial rhythm in an area of low socioeconomic status. There was no sex difference in the primary outcome for the main EMS-treated cohort or in the non-cardiac sub-cohorts. The sex difference in outcome in the presumed cardiac sub-cohort was not present after multivariable adjustment.
There are sex differences in incidence and outcome of EMS-treated OHCA that appear to be driven by differences in susceptibility to cardiac arrhythmias and underlying etiology, rather than treatment delays or disparities.
院外心脏骤停（OHCA）的表现和特征在病因推测为心脏性的队列研究中已明确存在性别差异，但在病因非心脏性的队列研究中尚未明确。本研究在一个地方卫生网络内，根据推测病因和判定病因，调查了性别对OHCA发病率和结局的影响。
对澳大利亚一个地方卫生网络内接受紧急医疗服务（EMS）的OHCA进行基于人群的观察性队列研究。从2012年至2016年EMS登记处识别出的病例与医院登记处进行了关联。按性别对接受EMS治疗的OHCA、非EMS目击的推测为心脏性和明显非心脏性亚队列以及住院病例的年龄标准化发病率和基线特征进行了分层。采用逻辑回归分析探讨出院存活这一主要结局。
我们识别出2024例接受EMS救治的OHCA和780例接受EMS治疗的OHCA。非EMS目击亚队列包括504例推测为心脏性的OHCA和168例明显非心脏性的OHCA。123例住院病例记录了判定病因。所有组中女性的年龄标准化发病率几乎是男性的一半。在各个队列中，女性通常年龄较大，且在社会经济地位较低地区发生心脏骤停时初始心律不可电击复律。主要接受EMS治疗的队列或非心脏性亚队列的主要结局在性别上无差异。在多变量调整后，推测为心脏性亚队列的结局性别差异不存在。
接受EMS治疗的OHCA的发病率和结局存在性别差异，这似乎是由对心律失常的易感性差异和潜在病因驱动的，而非治疗延迟或差异。
