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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Perman SM, Shelton SK, Knoepke C, Rappaport K, Matlock DD, Adelgais K, Havranek EP, Daugherty SL. Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out-of-Hospital Cardiac Arrest. Circulation 2019; 139:1060-1068. [PMID: 30779655 DOI: 10.1161/circulationaha.118.037692] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women who suffer an out-of-hospital cardiac arrest receive bystander cardiopulmonary resuscitation (CPR) less often than men. Understanding public perceptions of why this occurs is a necessary first step toward equitable application of this potentially life-saving intervention. METHODS We conducted a national survey of members of the public using Mechanical Turk, Amazon's crowdsourcing platform, to determine reasons why women might receive bystander CPR less often than men. Eligible participants were adults (≥18 years) located in the United States. Responses were excluded if the participant was not able to define CPR correctly. Participants were asked to answer the following free-text question: "Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?" Descriptive statistics were used to define the cohort. The free-text response was coded using open coding, and major themes were identified via classical content analysis. RESULTS In total, 548 subjects were surveyed. Mean age was 38.8 years, and 49.8% were female. Participants were geographically distributed as follows: 18.5% West, 9.2% Southwest, 22.0% Midwest, 27.5% Southeast, and 22.9% Northeast. After analysis, 3 major themes were detected for why the public perceives that women receive less bystander CPR. They include the following: (1) sexualization of women's bodies; (2) women are weak and frail and therefore prone to injury; and (3) misperceptions about women in acute medical distress. Overall, 41.9% (227) were trained in CPR while 4.4% reported having provided CPR in a medical emergency. CONCLUSIONS Members of the general public perceive fears about inappropriate touching, accusations of sexual assault, and fear of causing injury as inhibiting bystander CPR for women. Educational and policy efforts to address these perceptions may reduce the sex differences in the application of bystander CPR.
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Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine (S.M.P., S.K.S.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Center for Women's Health Research (S.M.P., C.K., S.L.D.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Group, Denver (S.M.P., C.K., D.D.M., E.P.H., S.L.D.)
| | - Shelby K Shelton
- Department of Emergency Medicine (S.M.P., S.K.S.), Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Christopher Knoepke
- Center for Women's Health Research (S.M.P., C.K., S.L.D.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Division of Cardiology (C.K., S.L.D.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Group, Denver (S.M.P., C.K., D.D.M., E.P.H., S.L.D.).,Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO (C.K., D.D.M., S.L.D.)
| | - Kathryn Rappaport
- Section of Emergency Medicine, Children's Hospital of Colorado, Aurora (K.R., K.A.)
| | - Daniel D Matlock
- Division of Geriatric Medicine (D.D.M.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Group, Denver (S.M.P., C.K., D.D.M., E.P.H., S.L.D.).,Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO (C.K., D.D.M., S.L.D.).,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO (D.D.M.)
| | - Kathleen Adelgais
- Section of Emergency Medicine, Children's Hospital of Colorado, Aurora (K.R., K.A.)
| | - Edward P Havranek
- Colorado Cardiovascular Outcomes Research Group, Denver (S.M.P., C.K., D.D.M., E.P.H., S.L.D.).,Department of Medicine, Denver Health Medical Center, CO (E.P.H.)
| | - Stacie L Daugherty
- Center for Women's Health Research (S.M.P., C.K., S.L.D.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Division of Cardiology (C.K., S.L.D.), Department of Medicine, University of Colorado School of Medicine, Aurora.,Colorado Cardiovascular Outcomes Research Group, Denver (S.M.P., C.K., D.D.M., E.P.H., S.L.D.)
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