March 12, 2019
Sex and the Heart
Understanding the disparity in CPR response rates between men and woman.
Female Sudden Cardiac Arrest Victims are Less Likely to Survive than Men
Sudden cardiac arrest (SCA) indiscriminately takes the lives of over 356,000 people a year (1), approximately 43% of whom are women (2). While often “structural heart problems” such as coronary artery disease (CAD) can lead to SCA (3), evidence suggests that SCA occurs more often in the absence of CAD in woman than in men (4); this makes it more difficult to diagnose SCA in women than in men.
“The lethality of SCA isn’t just a man’s problem, though contemporary society routinely cast men as the victims throughout popular culture,” says Sameer Jafri, the Co-founder, President, and COO of Avive Solutions, a San Francisco-based company working to bring a next-generation AED to the market.
“More troubling, perhaps, is that evidence also points to women receiving significantly less help during SCA incidents.”
In a research study presented during the 2017 American Heart Association’s Scientific Sessions conference (5), researchers analyzed data from 19,331 cardiac arrest events at home and in public and found that "although there are no significant gender differences in CPR performed on cardiac events in the home, a higher percentage of men (45%) receive assistance from bystanders in public compared to 39% of women. The study found that men were 1.23 times more likely to receive bystander CPR in public settings, and they had 23% increased odds of survival compared to women."
“Performing CPR can double – or triple – the victim’s chances of survival from SCA. And, given the fact that hundreds of thousands of people die from SCA each year, even modest improvements in administering CPR can save thousands of women’s lives each year,” says Jafri.
In another study (6), participants wore virtual reality headsets to simulate a CPR rescue attempt. The participants were not informed of the type of rescue situation or the sex of the victim. According to an American Heart Association Recap, “The team’s findings showed that in their descriptive study, participants in their cohort performed CPR or used an AED on virtual-reality female victims less than on virtual male victims.” (7)
There are many reasons would-be-rescuers cite as a rationale for not responding to women in need; principally, that their actions might be deemed to be inappropriate, lewd, or some form of sexual assault (8). In fact, even those who have responded to a woman in need have been criticized for doing so. In a remarkable, if not unbelievable rescue, a Japanese man came to the rescue of a woman in cardiac arrest. As certified training and all automated external defibrillation (AED) procedures require, he removed all clothing from her chest, including her bra, at which time bystanders called him a “pervert” and called the police. He proceeded with the rescue and, after the woman was transported to the hospital, police arrived and questioned him about their reports of “acting inappropriately at the scene of an accident.” Upon explaining the situation and AED rescue procedures, he was released. Oh, and he saved the woman’s life (9).
The public reaction to this rescue highlights several important points. First, the responder coming to the aid of a woman in need was an action of the minority. Second, and equally concerning, police were called for a man rendering aid to a woman in need though he was doing what he was trained to do (and his training worked because she survived!). If police are called (and the police respond by “questioning” the rescuer), we’re given a sense of how common the public’s view of the wrong action is versus the correct alternative.
“If 911 is called when bystanders respond to a woman in distress – not because there’s a general emergency requiring EMS, but because they think the responder is acting inappropriately – we, as a CPR and AED community, have a lot more work to do!” says Jafri.
Some, like Founder and Executive Director of Racing Hearts’ Stephanie Martinson, are doing all they can to help anyone in need. "Since being diagnosed with HCM when I was 23 years old, I've learned that there are thousands of people who simply don’t know their risk. I founded Racing Hearts in 2013 with the goal of changing the mindset about Sudden Cardiac Arrest and that AEDs are a simple solution to a huge medical problem. In partnership with the Santa Clara County Board of Supervisors, Racing Hearts is thrilled to share that our county is the first statewide to have AEDs in all public schools, patrol, and sheriff cars."
"Last year we documented 8 AED saves. More saves have already occurred in 2019. Together we can see more lives saved and that everyone has a chance to live a full and active life no matter their gender."
While performing human factors testing for the general usability of their new AED, Mr. Jafri and his team immediately noticed hesitation by male respondents to utilize an AED on a female manikin. He shares that "during all human factors testing, our goal is to learn as much as we can from a wide demographic of respondents, from males and females of all ages to untrained rescuers who have never seen an AED before, to trained health care providers with extensive AED familiarity. During our initial formative human factors studies, it was fascinating to observe the hesitancy that nearly all men had with responding to a female mannikin in even a controlled setting where they were assured that there would be no repercussions for their actions and there was no ‘wrong action.’"
These important human factors studies have led to some novel product features and voice prompts that don’t exist with currently approved AED units in the United States.
“We hope to have found a way to encourage treatment of everyone who experiences SCA, not just men.”
(1) The American Heart Association. “The Heart Disease and Stroke Statistics - 2013 Update” January 31, 2018. Circulation. 2018;137:e67–e492.
(2) Sumeet S. Chugh et al., "Women Have A Lower Prevalence Of Structural Heart Disease As A Precursor To Sudden Cardiac Arrest", Journal Of The American College Of Cardiology 54, no. 22 (2009): 2006-2011, doi:10.1016/j.jacc.2009.07.038.
(3) Puja K. Mehta et al., "Sudden Cardiac Death In Women With Suspected Ischemic Heart Disease, Preserved Ejection Fraction, And No Obstructive Coronary Artery Disease: A Report From The Women's Ischemia Syndrome Evaluation Study", Journal Of The American Heart Association 6, no. 8 (2017), doi:10.1161/jaha.117.005501.
(4) Sumeet S. Chugh et al., "Women Have A Lower Prevalence Of Structural Heart Disease As A Precursor To Sudden Cardiac Arrest", Journal Of The American College Of Cardiology 54, no. 22 (2009): 2006-2011, doi:10.1016/j.jacc.2009.07.038.
(5) "Men More Likely To Receive Bystander CPR In Public Than Women | American Heart Association", Newsroom.Heart.Org, 2019, https://newsroom.heart.org/news/men-more-likely-to-receive-bystander-cpr-in-public-than-women.
(6) "Two Novel Studies Explore Why Women Receive Less CPR From Bystanders | American Heart Association", Newsroom.Heart.Org, 2019, https://newsroom.heart.org/news/two-novel-studies-explore-why-women-receive-less-cpr-from-bystanders.
(8) American Heart Association. "Why women receive less CPR from bystanders." ScienceDaily. www.sciencedaily.com/releases/2018/11/181105105453.htm (accessed March 1, 2019).
(9) W Fran, "Man Revives Woman with AED, Branded A "Pervert" For Removing Her Clothes to Apply Electrode Pads", Soranews24, 2019, https://soranews24.com/2014/10/22/man-revives-woman-with-aed-branded-a-pervert-for-removing-her-clothes-to-apply-electrode-pads/.