Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations – A study from the CARES Investigators
Women experience worse neurological outcomes following out-of-hospital cardiac arrest (OHCA). It is unknown whether sex disparities exist in the use of targeted temperature management (TTM), a standard of care treatment to improve neurological outcomes. We performed a retrospective study of prospect...
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| Veröffentlicht in: | Resuscitation 2021-12, Vol.169, p.97-104 |
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| creator | Morris, Nicholas A. Mazzeffi, Michael McArdle, Patrick May, Teresa L. Burke, James F. Bradley, Steven M. Agarwal, Sachin Badjatia, Neeraj Perman, Sarah M. |
| description | Women experience worse neurological outcomes following out-of-hospital cardiac arrest (OHCA). It is unknown whether sex disparities exist in the use of targeted temperature management (TTM), a standard of care treatment to improve neurological outcomes.
We performed a retrospective study of prospectively collected patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival from 2013 through 2019. We compared receipt of TTM by sex in a mixed-effects model adjusted for patient, arrest, neighborhood, and hospital factors, with the admitting hospital modeled as a random intercept.
Among 123,419 patients, women had lower rates of shockable rhythms (24.4 % vs. 39.2%, P |
| doi_str_mv | 10.1016/j.resuscitation.2021.10.036 |
| format | Article |
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We performed a retrospective study of prospectively collected patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival from 2013 through 2019. We compared receipt of TTM by sex in a mixed-effects model adjusted for patient, arrest, neighborhood, and hospital factors, with the admitting hospital modeled as a random intercept.
Among 123,419 patients, women had lower rates of shockable rhythms (24.4 % vs. 39.2%, P < .001) and lower rates of presumed cardiac aetiologies for arrest (74.3% vs. 81.1%, P < .001). Despite receiving a similar rate of TTM in the field (12.1% vs. 12.6%, P = .02), women received less TTM than men upon admission to the hospital (41.6% vs. 46.4%, P < .001). In an adjusted mixed-effects model, women were less likely than men to receive TTM (Odds Ratio 0.91, 95% Confidence Interval 0.89 to 0.94). Among the 27,729 patients with data indicating the reason for not using TTM, a higher percentage of women did not receive TTM due to Do-Not-Resuscitate orders/family requests (15.1% vs. 11.4%, p < .001) and non-shockable rhythms (11.1% vs. 8.4%, p < .001).
We found that women received less TTM than men, likely due to early care limitations and a preponderance of non-shockable rhythms.</description><identifier>ISSN: 0300-9572</identifier><identifier>EISSN: 1873-1570</identifier><identifier>DOI: 10.1016/j.resuscitation.2021.10.036</identifier><identifier>PMID: 34756958</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Cardiac arrest ; Cardiopulmonary Resuscitation ; Disparities ; Female ; Healthcare disparities ; Heart arrest ; Humans ; Hypothermia, Induced ; Induced hypothermia ; Male ; Odds Ratio ; Out-of-Hospital Cardiac Arrest - therapy ; Post cardiac arrest care ; Registries ; Retrospective Studies ; Sex ; Sex factors ; Targeted temperature management ; Therapeutic hypothermia ; Therapeutics</subject><ispartof>Resuscitation, 2021-12, Vol.169, p.97-104</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c298t-4b69b5c9fc02ca22baaba7628f43e21f526a19f521c911f7201d081a64e861a43</citedby><cites>FETCH-LOGICAL-c298t-4b69b5c9fc02ca22baaba7628f43e21f526a19f521c911f7201d081a64e861a43</cites><orcidid>0000-0003-4006-6760 ; 0000-0002-1270-9805 ; 0000-0002-9130-8013 ; 0000-0003-1509-9034</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.resuscitation.2021.10.036$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34756958$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morris, Nicholas A.</creatorcontrib><creatorcontrib>Mazzeffi, Michael</creatorcontrib><creatorcontrib>McArdle, Patrick</creatorcontrib><creatorcontrib>May, Teresa L.</creatorcontrib><creatorcontrib>Burke, James F.</creatorcontrib><creatorcontrib>Bradley, Steven M.</creatorcontrib><creatorcontrib>Agarwal, Sachin</creatorcontrib><creatorcontrib>Badjatia, Neeraj</creatorcontrib><creatorcontrib>Perman, Sarah M.</creatorcontrib><creatorcontrib>the CARES Surveillance Group</creatorcontrib><creatorcontrib>CARES Surveillance Group</creatorcontrib><title>Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations – A study from the CARES Investigators</title><title>Resuscitation</title><addtitle>Resuscitation</addtitle><description>Women experience worse neurological outcomes following out-of-hospital cardiac arrest (OHCA). It is unknown whether sex disparities exist in the use of targeted temperature management (TTM), a standard of care treatment to improve neurological outcomes.
We performed a retrospective study of prospectively collected patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival from 2013 through 2019. We compared receipt of TTM by sex in a mixed-effects model adjusted for patient, arrest, neighborhood, and hospital factors, with the admitting hospital modeled as a random intercept.
Among 123,419 patients, women had lower rates of shockable rhythms (24.4 % vs. 39.2%, P < .001) and lower rates of presumed cardiac aetiologies for arrest (74.3% vs. 81.1%, P < .001). Despite receiving a similar rate of TTM in the field (12.1% vs. 12.6%, P = .02), women received less TTM than men upon admission to the hospital (41.6% vs. 46.4%, P < .001). In an adjusted mixed-effects model, women were less likely than men to receive TTM (Odds Ratio 0.91, 95% Confidence Interval 0.89 to 0.94). Among the 27,729 patients with data indicating the reason for not using TTM, a higher percentage of women did not receive TTM due to Do-Not-Resuscitate orders/family requests (15.1% vs. 11.4%, p < .001) and non-shockable rhythms (11.1% vs. 8.4%, p < .001).
We found that women received less TTM than men, likely due to early care limitations and a preponderance of non-shockable rhythms.</description><subject>Cardiac arrest</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Disparities</subject><subject>Female</subject><subject>Healthcare disparities</subject><subject>Heart arrest</subject><subject>Humans</subject><subject>Hypothermia, Induced</subject><subject>Induced hypothermia</subject><subject>Male</subject><subject>Odds Ratio</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Post cardiac arrest care</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Sex</subject><subject>Sex factors</subject><subject>Targeted temperature management</subject><subject>Therapeutic hypothermia</subject><subject>Therapeutics</subject><issn>0300-9572</issn><issn>1873-1570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU2OEzEQhS3EiMkMXAGVxIZNB9v9L1ZRFJiRRkIaQCytand1xlF3O9juoOy4A8fgVnOScSsBiR2rWrz36lXpY-yN4EvBRfFut3TkJ69NwGDsuJRciqgseVo8YwtRlWki8pI_Zwuecp7UeSkv2ZX3O855mtflC3aZZmVe1Hm1YL-_2YFGcKTJHAh68h4Cui0FaiHQsCeHYXIEA464pegNEB5whDnV2b63P8y4BTuFxHbJg_X7eFYPGl1rUAO6eGuAdiIIFghdf5y1WGSG8_0eHn_-ghX4MLVH6JwdYgHBenW_-Qy34yHmzRaDdf4lu-iw9_TqPK_Z1w-bL-ub5O7Tx9v16i7Rsq5CkjVF3eS67jSXGqVsEBssC1l1WUpSdLksUNRxCF0L0ZWSi5ZXAouMqkJgll6zt6e9e2e_T7FfDcZr6nscyU5eybwuuEiFnK3vT1btrPeOOrV3ZkB3VIKrmZbaqX9oqZnWLEZaMf36XDQ1A7V_s3_wRMPmZKD47sGQU3ERjZpaE4kF1VrzX0VPXQuy9Q</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>Morris, Nicholas A.</creator><creator>Mazzeffi, Michael</creator><creator>McArdle, Patrick</creator><creator>May, Teresa L.</creator><creator>Burke, James F.</creator><creator>Bradley, Steven M.</creator><creator>Agarwal, Sachin</creator><creator>Badjatia, Neeraj</creator><creator>Perman, Sarah M.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4006-6760</orcidid><orcidid>https://orcid.org/0000-0002-1270-9805</orcidid><orcidid>https://orcid.org/0000-0002-9130-8013</orcidid><orcidid>https://orcid.org/0000-0003-1509-9034</orcidid></search><sort><creationdate>202112</creationdate><title>Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations – A study from the CARES Investigators</title><author>Morris, Nicholas A. ; Mazzeffi, Michael ; McArdle, Patrick ; May, Teresa L. ; Burke, James F. ; Bradley, Steven M. ; Agarwal, Sachin ; Badjatia, Neeraj ; Perman, Sarah M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-4b69b5c9fc02ca22baaba7628f43e21f526a19f521c911f7201d081a64e861a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiac arrest</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Disparities</topic><topic>Female</topic><topic>Healthcare disparities</topic><topic>Heart arrest</topic><topic>Humans</topic><topic>Hypothermia, Induced</topic><topic>Induced hypothermia</topic><topic>Male</topic><topic>Odds Ratio</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Post cardiac arrest care</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Sex</topic><topic>Sex factors</topic><topic>Targeted temperature management</topic><topic>Therapeutic hypothermia</topic><topic>Therapeutics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morris, Nicholas A.</creatorcontrib><creatorcontrib>Mazzeffi, Michael</creatorcontrib><creatorcontrib>McArdle, Patrick</creatorcontrib><creatorcontrib>May, Teresa L.</creatorcontrib><creatorcontrib>Burke, James F.</creatorcontrib><creatorcontrib>Bradley, Steven M.</creatorcontrib><creatorcontrib>Agarwal, Sachin</creatorcontrib><creatorcontrib>Badjatia, Neeraj</creatorcontrib><creatorcontrib>Perman, Sarah M.</creatorcontrib><creatorcontrib>the CARES Surveillance Group</creatorcontrib><creatorcontrib>CARES Surveillance Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morris, Nicholas A.</au><au>Mazzeffi, Michael</au><au>McArdle, Patrick</au><au>May, Teresa L.</au><au>Burke, James F.</au><au>Bradley, Steven M.</au><au>Agarwal, Sachin</au><au>Badjatia, Neeraj</au><au>Perman, Sarah M.</au><aucorp>the CARES Surveillance Group</aucorp><aucorp>CARES Surveillance Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations – A study from the CARES Investigators</atitle><jtitle>Resuscitation</jtitle><addtitle>Resuscitation</addtitle><date>2021-12</date><risdate>2021</risdate><volume>169</volume><spage>97</spage><epage>104</epage><pages>97-104</pages><issn>0300-9572</issn><eissn>1873-1570</eissn><abstract>Women experience worse neurological outcomes following out-of-hospital cardiac arrest (OHCA). It is unknown whether sex disparities exist in the use of targeted temperature management (TTM), a standard of care treatment to improve neurological outcomes.
We performed a retrospective study of prospectively collected patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival from 2013 through 2019. We compared receipt of TTM by sex in a mixed-effects model adjusted for patient, arrest, neighborhood, and hospital factors, with the admitting hospital modeled as a random intercept.
Among 123,419 patients, women had lower rates of shockable rhythms (24.4 % vs. 39.2%, P < .001) and lower rates of presumed cardiac aetiologies for arrest (74.3% vs. 81.1%, P < .001). Despite receiving a similar rate of TTM in the field (12.1% vs. 12.6%, P = .02), women received less TTM than men upon admission to the hospital (41.6% vs. 46.4%, P < .001). In an adjusted mixed-effects model, women were less likely than men to receive TTM (Odds Ratio 0.91, 95% Confidence Interval 0.89 to 0.94). Among the 27,729 patients with data indicating the reason for not using TTM, a higher percentage of women did not receive TTM due to Do-Not-Resuscitate orders/family requests (15.1% vs. 11.4%, p < .001) and non-shockable rhythms (11.1% vs. 8.4%, p < .001).
We found that women received less TTM than men, likely due to early care limitations and a preponderance of non-shockable rhythms.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>34756958</pmid><doi>10.1016/j.resuscitation.2021.10.036</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4006-6760</orcidid><orcidid>https://orcid.org/0000-0002-1270-9805</orcidid><orcidid>https://orcid.org/0000-0002-9130-8013</orcidid><orcidid>https://orcid.org/0000-0003-1509-9034</orcidid></addata></record> |
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| ispartof | Resuscitation, 2021-12, Vol.169, p.97-104 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Cardiac arrest Cardiopulmonary Resuscitation Disparities Female Healthcare disparities Heart arrest Humans Hypothermia, Induced Induced hypothermia Male Odds Ratio Out-of-Hospital Cardiac Arrest - therapy Post cardiac arrest care Registries Retrospective Studies Sex Sex factors Targeted temperature management Therapeutic hypothermia Therapeutics |
| title | Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations – A study from the CARES Investigators |
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