Cardiac arrest: why do women survive less than men?

Statistics reveal a great injustice: when suffering cardiac arrest, women are half as likely to survive as men. This observation is linked in particular to perceptions, but it is not inevitable.

Alarming figures

It’s a chilling statistic: in cases of cardiac arrest occurring outside of a hospital, women are twice as likely to die as men. There are many reasons for this, mainly related to social and cultural stereotypes ingrained in the collective unconscious. First, it should be noted that most cases of CAR occur in front of witnesses—seven out of ten, in fact. And in nine out of ten cases, people only survive if someone intervenes quickly to perform first aid.

However, it is primarily the symptoms that alert us to the onset of cardiac arrest. In men, these are usually chest pains. In women, these symptoms also occur, but they can also take the form of nausea, shortness of breath, and intense fatigue, which are not necessarily recognized as warning signs by the victims themselves, their loved ones, or witnesses.

What’s more, there is a whole set of preconceptions surrounding this issue: it is easier to associate the causes of some cardiac arrests with behaviors considered masculine, such as an unhealthy diet, smoking, and alcohol consumption. However, these habits have obviously not been the preserve of men for a long time, if they ever were exclusively so. They are also responsible for reducing the natural protection afforded to women until menopause, even though their hormonal situation may expose them to greater risk, for example through contraception or during pregnancy. In any case, failure to identify the problem delays treatment for the person suffering cardiac arrest. But other factors then complicate matters.

Le contact redouté

The second major obstacle is reluctance to make physical contact: again, this is a documented fact and involves a form of hesitation when performing CPR or even placing defibrillator electrodes, for fear of making an inappropriate gesture on the chest. This can waste precious seconds, which is all the more regrettable given that CPR is performed on the sternum, the bone in the middle of the chest, and not on the breast itself.

This reality is part of a broader bias, referred to in medical literature as the Yentl syndrome: a tendency to underdiagnose or undertreat women, particularly for cardiovascular diseases, because clinical guidelines have historically been built around “typical” male symptoms.

What is Yentl syndrome?

Yentl syndrome refers to a medical bias whereby women are less likely to be diagnosed and treated than men, except when they present symptoms identical to those considered “masculine.” The term comes from the character Yentl, from Isaac Bashevis Singer’s short story Yentl the Yeshiva Boy, who must pretend to be a man in order to be recognized. In healthcare, this syndrome manifests itself in the invisibility of female symptoms, the underestimation of pain, and delays in treatment, particularly in cardiology, where atypical signs in women have long been ignored.

The observation of such a difference in care, and therefore such injustice, is obviously chilling. However, it is not inevitable. Healthcare professionals are proposing several ways to give women a better chance of survival.

Actions to be taken

First, raise awareness of the warning signs specific to women, in order to reduce delays in recognizing the symptoms and calling for help. This is what the Fondation Agir pour le Cœur des Femmes (Act for Women’s Hearts Foundation) is proposing, through hard-hitting campaigns such as the one launched in the fall of 2024.

Another area of focus is training the general public to respond without hesitation, regardless of the victim’s appearance or gender. In CPR training courses, instructors are increasingly encouraged to take this particular factor into account. They now have access to training mannequins that also represent female bodies.

Today, 200 women die every day in France from cardiovascular disease—heart attack, stroke, or embolism—against which prevention and rapid response can often make a difference.

The gender gap in survival rates following cardiac arrest is not inevitable. It reveals systemic flaws in our perception of and response to emergencies, but it also points to clear courses of action: better information, better training, and above all, never hesitating to resuscitate. Because those first few minutes are crucial to the chances of survival…

At the Liryc Institute, research into women’s health is a priority.