Abstract 19902: Differences in Targeted Temperature Management Utilization by Gender
Introduction: Gender differences have been observed in various disease states in acute emergency care, for example women receive less or delayed emergent angiography for myocardial infarction and less or delayed thrombolytic therapy for acute cerebrovascular accidents. Women also have lower rates of survival to hospital discharge after cardiac arrest.
Hypothesis: To explore why gender differences exist in cardiac arrest outcomes, we hypothesized that women may receive less targeted temperature management (TTM) than men.
Methods: Resuscitated adult patients who were comatose after return of spontaneous circulation were identified from a multi-center US registry. To control for patient and arrest variables that may influence whether a patient receives treatment, we built a propensity score for TTM that accounted for age, location of arrest, witnessed arrest, duration of arrest, and initial rhythm. Patients were placed into deciles based on propensity score (0-1). We analyzed the relationship between gender and treatment with TTM by decile of propensity score.
Results: We included 1601 patients from 27 hospitals treated between 2005-2016. Mean age was 63.3±16.2 years, 60.1% were male, 53.8% received TTM, and 26.9% survived to hospital discharge. Overall, men were more likely to receive TTM than women (OR: 1.18, 95% CI: 0.94-1.49, p=0.15). This difference was not significant when controlling for propensity score, but was in univariate analysis (p=0.012). When the likelihood of receiving TTM was <50%, women received significantly less TTM than men (OR: 0.70, 95% CI: 0.49-0.99, p=0.04). Treatment with TTM varied significantly by gender in certain deciles of propensity score.
Conclusions: Women receive less TTM than men, but this difference does not achieve statistical significance when controlling for patient and arrest factors. However, when the likelihood of receiving TTM was <50%, women received significantly less TTM than men.
Author Disclosures: S.M. Perman: Research Grant; Significant; NIH BIRCWH K12. D.F. Gaieski: None. S.L. Daugherty: None. E.P. Havranek: None. B.S. Abella: Research Grant; Significant; NHLBI, AHA, PCORI, CR Bard, Medrtonic. Honoraria; Modest; CR Bard, Physio-Control. Consultant/Advisory Board; Modest; Ikaria, CardioReady. M.W. Donnino: Research Grant; Significant; NIH, AHA. A.V. Grossestreuer: Research Grant; Significant; AHA.
- © 2016 by American Heart Association, Inc.