Abstract
BackgroundOut-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. However, conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after OHCA. Therefore, we investigated the relationship between the prognosis of OHCA and sex factors.MethodsWe comprehensively searched the PubMed, Embase, and Cochrane databases and obtained a total of 1042 articles, from which 33 studies were selected for inclusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.ResultsThe meta-analysis included 1,268,664 patients. Compared with males, females were older (69.7 years vs. 65.4 years, p < 0.05) and more frequently suffered OHCA without witnesses (58.39% vs 62.70%, p < 0.05). Females were less likely to receive in-hospital interventions than males. There was no significant difference between females and males in the survival from OHCA to hospital admission (OR 0.99, 95% CI 0.89–1.1). However, females had lower chances for survival from hospital admission to discharge (OR 0.59, 95% CI 0.48–0.73), overall survival to hospital discharge (OR 0.73, 95% CI 0.62–0.86), and favorable neurological outcomes (OR 0.62, 95% CI 0.47–0.83) compared with males.ConclusionsOur results indicate that the overall discharge survival rate of females is lower than that of males, and females face a poor prognosis of the nervous system. This is likely related to the pathophysiological characteristics of females, more conservative treatment measures compared with males, and different post-resuscitation care. However, these findings should be interpreted with caution due to the presence of several confounding factors.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide
Sex differences in survival after OHCA Fifteen of the 33 studies were used to analyze the differences in survival from OHCA to admission, and we found no significant difference in survival from OHCA to admission between males and females (Fig. 2)
The results showed that the neurological prognosis of females after OHCA was not as optimistic as that of males; females had a lower probability of good neurological prognosis than males (Fig. 5)
Summary
Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. Out-of-hospital cardiac arrest (OHCA) refers to the sudden loss of heart function outside of the hospital, which leads to complete cessation of systemic circulation. Previous studies have shown that the prognosis of OHCA is related to factors such as age, primary disease, bystander cardiopulmonary resuscitation, and initial heart rhythm. Research has identified differences in the medical services received by males and females after admission [7, 8]. Various studies have shown that there is a significant correlation between sex and the pathophysiology and prognosis of cardiovascular disease. Especially young females, fare worse than men after acute myocardial infarction [10]
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