Women and cardiac arrest: what if it were you?

Tough prejudices

When cardiac arrest occurs outside the hospital, women have 2 times the risk of death compared to men (European heart journal 2019; Eur J Emerg Med. 2021). In a public place, women are less likely to receive cardiac massage from a bystander than men, leading to more deaths among them (The Lancet CommissionsVolume 402, Issue 10405p883-936September 09, 2023). Why is this? Because women are victims of persistent prejudices about cardiac arrest.

The first barrier is the lack of recognition of cardiac arrest itself, considered a male event. Yet more and more women are affected. Unfortunately, they have adopted men's unhealthy lifestyle habits: lack of physical activity, unbalanced diet, smoking, alcohol, stress...
This lifestyle diminishes the natural protection provided by their natural hormones until menopause. Because women's arteries are thinner, they are more sensitive than men's to conventional risk factors. What's more, their hormonal situation may put some women at greater risk of heart disease (contraception with estrogen, pregnancy and post-partum, menopause).

The second barrier is the fear of massaging a woman's chest. Some passers-by are embarrassed to touch a woman's chest, others think that breasts impede effective cardiac massage.

Women's obstacle course in the face of cardiac arrest doesn't end there. Endowed with a higher life expectancy than men, they are more likely than men to live alone later in life. And when cardiac arrest occurs at home, without witnesses, the chances of survival decrease drastically (Resuscitation Volume 185, April 2023, 109693).

Alerter: knowing the major signs that help save lives

"If cardiac arrest strikes without warning, the disease that caused it gives warning symptoms, explains Pr Claire Mounier-Vehier, co-founder of Agir pour le Cœur des Femems, cardiologist and vascular physician at Lille University Hospital... Knowing them can save your life or the lives of others. In women, the most frequent symptoms are great fatigue on exertion, shortness of breath and digestive signs, nausea and stomach pains, which occur before the severe chest pain."

American research carried out on 3,000 people, to accurately identify the warning signs of cardiac arrest showed that 50% of patients suffering cardiac arrest, had experienced one or more warning symptoms one day before the event. (The Lancet Commissions Volume 402, Issue 10405p883-936September 09, 2023; Lancet Digit Health. 2023 Nov;5(11):e763-e773.) Some of these signs and symptoms differed between men and women. In women, the most frequent warning symptoms were shortness of breath but alsodigestive signs (nausea and stomach pain). In men, these were chest pain, sometimes intense.

Other warning signs of cardiac arrest can occur in both sexes, such as: a sensation of oppression or crushing of the rib cage, palpitations, malaise, dizziness or vertigo. They may be followed by loss of consciousness. These warning signs are less well diagnosed in women, who pay less attention to their own health than to that of their loved ones.

The European ESCAPE-NET registry has compiled data from over 100,000 people who suffered cardiac arrest (Am Heart J 2022 Mar:245:117-125). It confirms that women do not (re)know the warning signs when they occur. These are often atypical symptoms with palpitations, extreme fatigue on exertion, epigastric discomfort and anxiety, tightness in the chest..

As a result, women contact the emergency services too late, because the major symptom that everyone can recognize - chest pain - doesn't always appear. And when the woman is rescued quickly, many bystanders still don't dare perform cardiac massage on their chest, out of embarrassment or fear of doing the wrong thing. In the end, it's a succession of lost opportunities, between the onset of symptoms, the call and the rescue. As a result, women survive cardiac arrest less than men.

Take action: when should you have a cardiovascular check-up?

Women need to listen to themselves and stop hesitating to be screened. Family antecedents, and particularly those of parents, are key indicators: if they have had coronary problems, you should inform your doctor and proceed with a cardiovascular check-up, particularly from the menopause onwards.

If a woman is suffering from a combination of risk factors, such as smoking and contraception, and is experiencing strange symptoms, she should consult her doctor as soon as possible, or call 15, especially if she has a hereditary background.

Knowing your risk factors, not minimizing unusual warning signs, and getting regular cardiovascular check-ups are the keys to successful prevention.

Three key consultations punctuate every woman's life and should take cardiovascular risk into account: the first contraception consultation, the consultation preceding the wish to become pregnant, the menopause consultation around the age of 50.

Act: 5 links to survival!

Cardiac arrest is an absolute vital emergency. It is therefore very important to act immediately. First aid must be performed as soon as possible, to increase the chances of survival for the person, victim of cardiac arrest.

5 survival links are essential to increase the victim's chances:
- 1. Recognize cardiac arrest
- 2. Alert emergency services(15 for SAMU, 18 for firefighters or 112 for the emergency number throughout the European Union): on the phone, explain the situation briefly and communicate the location. Stay on the line with the emergency services throughout the treatment.
- 3. Dare to massage and effectively: by positioning yourself above the victim, placed on a hard surface. Arms should always be outstretched. Place palms one on top of the other, in the middle of the chest and apply pressure to the ribcage, then release. Press 100 times a minute (to the rhythm of Stayn' Alive by the Beegees). There's absolutely no need for mouth-to-mouth resuscitation. Another important point: massaging a beating heart has no consequences. Daring to massage can really make the difference between life and death.
- 4. Fearlessly use the external defibrillator:if there is one nearby, it will be brought in by another bystander, while waiting for help to arrive. Once the defibrillator is in hand, open the case and switch on the device. The defibrillator transmits instructions orally: all you have to do is follow them.
- 5. Pass the baton to the rescue teams.

The Foundation Acting for Women's Hearts informs women and the general public about the 5 links in the chain of survivalon its Women's Heart Bus Health - Wellness Villages and Women's Heart Day. This information is delivered by specialized teams who train visitors: Samu, sapeurs-pompiers, Croix Rouge Française, Protection Civile.

Find out more: Cardiac arrest: definition, causes and risks
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