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How could it be that women are at far greater risk of dying from sudden cardiac arrest than men? 

Recently, I experienced two occurrences of arrhythmia in one day. My heart was beating crazily, and I felt dizzy and a bit sick, leading my concerned husband to call for an ambulance. The wonderful paramedics checked me over then took me off to emergency care at the hospital. I lay there for six hours undergoing every test under the sun. Then I visited my GP for a HeartBug monitor and a referral for an echocardiogram.

At this point no one has found anything wrong. The arrhythmia might just be ‘one of those things’. Hardly comforting considering the potential consequences.

Which leads me to a 2019 University of Amsterdam study, published by the European Society of Cardiology and covered in ScienceDaily, that reveals women are twice as likely to die from a sudden cardiac arrest – which occurs when the heart goes into an irregular rhythm and then stops beating completely – than men.

The study’s researchers found men and women were not treated equally when having a sudden cardiac arrest, with women experiencing lower survival rates at each successive stage of care. In many cases, bystanders did not recognise that a woman who had collapsed was having a sudden cardiac arrest, leading to delays in both calling for the emergency services and in providing resuscitation. Even in hospital, women are less likely to be accurately diagnosed.

However, if women are diagnosed correctly and receive the appropriate treatment in a timely manner, their survival rates are the same as men. So, why aren’t they? Apparently:

  • Symptoms of a heart attack (one of the most common causes of cardiac arrest) may not be recognised as easily in women as in men, as their symptoms can be different
  • People are not aware that cardiac arrest occurs just as frequently in women as in men
  • Bystanders don’t think it is a life-threatening situation
  • Male rescuers can refrain from giving CPR to a woman for fear of being accused of sexual assault or inappropriate touching
  • Female rescuers may not provide assistance for fear of harming the victim
  • People feel less comfortable carrying out CPR on a woman because of her breasts and the challenges around getting a bra off quickly 
  • Religious sensitivity.

For those who don’t know (I didn’t), people performing CPR or defibrillation on a victim of sudden cardiac arrest, or assisting those who are injured, ill or in danger, are protected by Good Samaritan Acts across Australia. According to BurkeMead Lawyers, the laws are intended to reduce bystanders’ hesitation to assist those in need, by providing protection to those who act in good faith.

Risk factors for women

Well-established risk factors can include high-blood pressure, high cholesterol, diabetes, obesity, unhealthy diet, physical inactivity and smoking. Risk factors specific to women include polycystic ovary syndrome, premature menopause, pregnancy complications, autoimmune disorders and their treatments, some cancer treatments and depression.

Sudden cardiac arrest or heart attack?

It is important to understand the difference between a sudden cardiac arrest and a heart attack, says Louise Dawson from Defibs Plus. A specialist in emergency and remote nursing, first medical emergency response, accident investigation, bystander CPR and defibrillation, she has worked closely with the emergency services.

“A sudden cardiac arrest is a condition in which the heart suddenly stops working normally and fails to function as an effective pump,” she explains.

“The condition is often caused by a fault in the heart’s electrical system. A person in cardiac arrest will be unresponsive and will not be breathing or not breathing normally. This is because blood is no longer being pumped through the heart to the brain, lungs and other vital organs.”

Someone having a heart attack, on the other hand, will usually be conscious.

“Chest pain is the most common heart attack symptom in both women and men,” Dawson adds. “However, women are more likely than men to have non-chest pain symptoms, such as indigestion, shortness of breath or difficulty breathing, jaw, shoulder and back pain, nausea or vomiting, fatigue, tiredness or dizziness. A heart attack may develop into a sudden cardiac arrest requiring resuscitation, including early bystander CPR and defibrillation via an Automatic External Defibrillator (AED).”

The chain of survival

So, what can be done for someone experiencing a sudden cardiac arrest? You need to follow what is termed the four-step ‘chain of survival’: recognise the symptoms, call for an ambulance (000), carry out early bystander CPR, and locate an AED and defibrillate.

“In every state, emergency services make it very clear that all bystanders need to understand the first four steps of the chain of survival,” Dawson says. “The chain of survival highlights the elements required for the successful delivery of emergency cardiovascular care to increase the likelihood of survival from a sudden cardiac arrest. However, as not everyone is capable of carrying out all four steps, you need to understand what you are comfortable to do.”

CPR needs to be used when a person is unresponsive and not breathing normally. Chest compressions should be commenced immediately and continued until an AED is applied. Dawson says that when performing compressions, if you are not on your own, change rescuers at least every two minutes to prevent rescuer fatigue and deterioration in chest compression quality, particularly depth. She adds that changing rescuers performing chest compressions should be done with a minimum of interruptions to compressions.

“With the defibrillation, it’s essential that an AED is at hand. This machine can deliver a measured electrical shock to help a person’s heart return to a normal rhythm when a potentially fatal arrhythmia (abnormal heart rhythm) is happening in your heart,” Dawson says. “It can be used by any bystanders, first-aiders or first-aid providers, first responders and health professionals. The resuscitation guidelines say: using the AED should not be restricted to trained personnel.”

With sudden cardiac arrest, time to defibrillation is a key factor that influences a person’s chance of survival. A defibrillator should be applied to the person who is unresponsive and not breathing normally as soon as it becomes available so that a shock can be delivered if necessary. However, a defibrillator should not be used if the person is conscious, breathing and has signs of circulation.

Once you have access to an AED, turn the machine on and follow the prompts. It will advise you to remove clothing from the chest, apply pads and continue with CPR (as this helps to keep the heart muscle pumping blood around the heart and brain).

“If you apply the pads to a person who doesn’t need to be shocked, you can rest assured that AEDs are able to accurately identify the cardiac rhythm as ‘shockable’ or ‘unshockable’,” Dawson says. “Also, don’t worry about doing the two breaths as that slows down the heart muscle; better to stay with CPR. Then the machine will advise to stop CPR and will analyse the heart rhythm and will advise whether to shock or not the shock the person. A fully automatic machine does it for you. A semi-automatic machine advises you to press a button. You continue with this cycle until help arrives.

“It is worthwhile for all of us to keep our first-aid training up to date.”

Why should golf clubs carry defibrillators?

“The emergency services will not be there within 10 minutes, yet this is the most critical time to carry out bystander CPR and defibrillation. Defibrillator accessibility therefore makes all the difference,” Dawson says, “and every second counts.”

She says, according to the American Heart Foundation, an AED should be accessible with a three-minute run. Again, the time to defibrillation is a key factor that influences survival. For every minute defibrillation is delayed, there is about a 10-percent reduction in survival rate. CPR alone will not save a person. Hence a defibrillator should be applied to the person in need as soon as it becomes available so that a shock can be delivered if necessary.

In fact, according to Mike Covey, managing director at Shield Training, it can take up to 30 minutes for an ambulance to arrive and paramedics to then gain access to the victim. The ambulance paramedics may have to overcome scenarios where they may need access via alternative gates, for example. It is therefore important for golf clubs to have critical incident planning in place.

Dawson concludes: “Golf clubs should carry as many defibrillators as possible – in the golf club and around the course. Golfers themselves, particularly if they are at risk, should be encouraged to carry them so they are well prepared. They are available in a variety of sizes, with some being ideal to fit into a golf bag, and range in price from $499 to $3,000, with training available.”

With what I’ve experienced, I’m now considering getting an AED for myself. Who knows when I might need it – or someone I’m with? 

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