Abstract 117: Menopause and Pulseless Electrical Activity
Introduction: There are significant sex differences in the presentation of out-of-hospital sudden cardiac arrest (SCA) and women are more likely to present with pulseless electrical activity (PEA). Reproductive age has been associated with better survival from SCA but associations with likelihood of PEA vs. ventricular fibrillation (VF) have not been evaluated.
Hypothesis: We hypothesized that women in the post-menopausal age group are more likely to present with PEA.
Methods: Female cases (age ≥18 years) were identified from an ongoing population-based study in the Northwest US (population one million). SCA cases determined by multiple sources are enrolled in the study after review of available medical records and circumstances of arrest, followed by a process of in-house adjudication. Presenting arrhythmia during SCA was identified from review of the rhythm strips (60% of cases) or as reported by the first responders. Pearson’s x2tests and independent samples t-test were used for univariate comparisons. Multivariable logistic regression was used to incorporate Utstein data elements associated with SCA in post-menopausal women (age ≥ 50 years).
Results: A total of 412 women presenting with VF or PEA (Jan 2002- Feb 2012) were included in the analysis. Overall, 53.9% were VF and majority (88.1%) were age ≥ 50 years. Post-menopausal women were more likely to present with PEA (49.0% vs. 24.5%, p = 0.001). There were no differences in witnessed status, arrest location, response time and return of spontaneous circulation (p ≥ 0.41). Post-menopausal women were less likely to receive bystander CPR (27.6% vs. 51.0%, p = 0.0008) or to survive to hospital discharge (20.1% vs. 45.8%, p < 0.0001). Compared to women of reproductive age, post-menopausal women were at least twice more likely to manifest with PEA [adjusted OR 2.4 (95% CI 1.17-4.95), p=0.02].
Conclusion: Post-menopausal women are more likely to present with pulseless electrical activity, a phenomenon that likely contributes to poor outcome from SCA compared to reproductive age women.
- © 2013 by American Heart Association, Inc.