By Saumya Joseph

(Reuters Health) – Women who suffer cardiac arrest outside of a hospital are less likely to receive help from bystanders and have less chance of survival than men, a recent Dutch study showed.

The results align with what a separate study found in the United States last year: men had an increased likelihood of receiving bystander support and greater chances of survival than women.

For the new study, conducted in a province in The Netherlands, Dr. Hanno Tan at the University of Amsterdam and colleagues looked at data on more than 5,700 people who had cardiac arrests in the community. All were treated by the local emergency medical services (EMS) – but before EMS arrived on the scene, only about 68 percent of women had received resuscitation attempts by bystanders, compared to about 73 percent of men.

“This points to some commonality here that is happening in multiple countries. It would be very interesting to see if that’s the same worldwide,” Dr. Lorrel Brown Toft of the University of Louisville School of Medicine in Kentucky, who was not involved in the study, told Reuters Heath by phone.

Tan’s team found that despite EMS attempts at resuscitation, only 12.5 percent of women survived and were discharged from the hospital, compared to about 20 percent of men.

Cardiac arrest involves the abrupt loss of heart function, breathing and consciousness. Chest compressions or CPR administered by bystanders cannot restore a normal heart rhythm, but it can buy time until emergency responders arrive, by maintaining blood flow to vital organs.

Bystanders play a crucial role, as the survival of a person in cardiac arrest depends on how quickly witnesses provide CPR and notify emergency services of the event.

In the new study, however, even when emergency care was provided promptly, women were only about half as likely as men to have a “shockable rhythm,” which is a heart rhythm that can potentially be reset with a defibrillator, to restart the heart, the researchers wrote in the European Heart Journal.

This difference, the authors say, may point to underlying biologic factors that cause the shockable rhythm to dissipate into a flat line more quickly in women than in men.

They found, for example, that women with cardiac arrest were more likely to be suffering from conditions associated with a lower shockable rhythm, such as stroke or type 2 diabetes.

On the other hand, the differences observed in the study could also be due to a longer delay before bystanders recognize that a woman is in cardiac arrest.

People may not realize that women can suffer cardiac arrests just like men, Tan told Reuters Health by phone.

“For a lot of us, cardiac arrest mostly occurs, not in hospital, but in public spaces. The bystander needs to know that women can suffer cardiac arrests just as much as men can,” said Tan.

Victims themselves may fail to recognize the warning signs of a cardiac event. For instance, symptoms of heart attack, a common trigger of cardiac arrest, may be overlooked by women, for whom the symptoms may manifest as fatigue, nausea or neck or jaw pain, while men tend to report more prominent symptoms such as chest pain.

Toft, a critical care cardiologist who directs CPR training programs, pointed out that while one cannot change how a cardiac arrest occurs, ensuring that women get bystander support just as often as men will help to improve survival.

There are many reasons why women may receive less bystander support than men. Women tend to outlive men and are more likely to be widowed or live alone, raising their chances of having cardiac events when no one is around. Bystanders may also have inhibitions about performing chest compressions on a woman.

Toft notes that even during simulated CPR training sessions, female victims are less likely to receive help than men.

“We need to realize that there are some barriers specific to women and if we can overcome those barriers and improve our training, we might help women more by standard CPR,” she added.

More information about performing CPR is available from the American Red Cross ( and from the UK’s National Health Service (

SOURCE: European Heart Journal, online May 21, 2019

(This story corrects Dr. Tan’s name in paragraph 5)