Abstract 16014: Gender Differences in Characteristics, Treatment and Outcomes in a Regional System of Cardiac Arrest Care

Introduction: Gender differences have been noted in outcomes from out-of-hospital cardiac arrest (OHCA) but remain poorly defined. The purpose of this study was to evaluate gender differences in OHCA characteristics, interventions, and outcomes. Methods: This is a retrospective analysis of registry data from a regionalized cardiac arrest system. Patients treated for OHCA with return of spontaneous circulation (ROSC) are transported to the nearest cardiac arrest receiving center with percutaneous coronary intervention (PCI) capability and therapeutic hypothermia protocols. Outcomes are reported to a single registry, from which all adult patients were identified from 2011 through 2014. The characteristics, treatment interventions, and outcomes were evaluated by gender and then further stratified by ECG presence of STEMI and initial rhythm. The adjusted odds ratio (OR) for survival with good neurologic outcome (defined as cerebral perfusion category (CPC) 1 or 2) was calculated for women compared to men. Results: There were 5174 OHCA in the registry, 3080 males and 2094 females. Women were older, median 71 years (inter-quartile range (IQR) 59-82) vs 66 (IQR 55-78) and, despite similar frequency of witnessed arrest, were less likely to present with a shockable rhythm (22% vs 35%, Risk Difference (RD) 13% 95%CI 11-15%) compared to men. Women were also less likely to have STEMI on the ECG (23% vs 32%, RD 13% 95%CI 7-11%) receive catheterization (11% vs 25%, RD 14% 95%CI 12-16%), PCI (5% vs 14%, RD 9% 95%CI 7-11%) or TH (33% vs 40%, RD 7% 95%CI 4-10%). Women had decreased survival to hospital discharge (33% vs 40%, RD 7% 95%CI 4-10%) and a lower proportion with good neurologic outcome (16% vs 24%, RD 8% 95%CI 6-10%). The differences persisted with stratification by STEMI or initial rhythm. However, after adjustment for age, arrest characteristics (initial rhythm, witness, bystander CPR), interventions (catheterization, PCI, and TH) and interaction between gender and treatment, female gender was not associated with decreased survival with good neurologic outcome, OR 0.9, 95%CI 0.7-1.1. Conclusion: Gender-related differences in OHCA characteristics and treatment (including PCI, catheterization, and TH) are independent predictors of outcome disparities.