title: Factors associated with poor survival in women experiencing cardiac arrest in a rural setting.
abstract: OBJECTIVE
  The purpose of this study was to determine whether gender differences exist in the characteristics and outcomes for out-of-hospital cardiac arrest (OHCA) occurring in a rural setting.
  
  
  BACKGROUND
  In urban settings, women have a lower incidence of OHCA than men but otherwise a comparable survival for ventricular fibrillation (VF) OHCA. Whether OHCA gender differences exist in rural settings is not clear.
  
  
  METHODS
  The study consisted of a prospective collection and analysis of nontraumatic, adult OHCA prompting a 911 call in six rural Indiana counties.
  
  
  RESULTS
  Over an average period of 2.2 years, 138 women and 250 men experienced OHCA (annual incidence rate: 56.4 per 100,000 men and 29.3 per 100,000 women). Women were older, less likely to experience OHCA in a public setting, more likely to be in an extended care facility, and less likely to have a witnessed arrest than were men. Women were less likely to present with an initial rhythm of VF than men (33.3% vs 53.6%, P < .001). Women in VF had a longer time interval from 911 call to first shock compared with men. Women had poorer survival to hospital discharge for all OHCA (2.2% vs 7.2%, P = .04) and VF OHCA (2.2% vs 13.4%, P = .05) compared with men. After age adjustment, female gender remained associated with a poorer OHCA survival outcome. With adjustment for all significant arrest characteristics, female gender was no longer associated with survival.
  
  
  CONCLUSIONS
  In a rural population, women suffering OHCA have a dismal survival rate likely because of multiple unfavorable arrest characteristics.
authors.affiliation: Department of Medicine, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Cline
authors.forename: Elisabeth
authors.initials: E
authors.lastname: von Der Lohe
authors.forename: Mary M
authors.initials: MM
authors.lastname: Newman
authors.forename: William J
authors.initials: WJ
authors.lastname: Groh
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D012424:Rural Population; D012737:Sex Factors