on this international women’s day…
By now, the concept that women may present with heart attacks differently than men is fairly widely recognized. You have probably heard that women may not have pain, or are more likely to describe symptoms of a heart attack as “discomfort,” isolated shoulder or back pain, or may even endorse shortness of breath as their primary symptom.
And while much work has been done to raise awareness about the recognition of atypical (though I am really not sure why we say atypical when we are talking about 50% of the population) symptoms of heart attacks, we still have a very long way to go when it comes to cardiac arrest (i.e., you are dead or close to it, the heart has stopped, and you need CPR).
Women are less likely to receive bystander CPR and less likely to have an AED used on them. Not surprisingly, they have lower chances of surviving a cardiac arrest and making it to the hospital. Furthermore, even if they make it to the hospital, their chances of leaving the hospital—and moreover leaving neurologically intact—are lower.
Why the disparities? There is a growing body of evidence exploring these differences, and the causes are complex and variable. But let’s try to break it down into some basic reasons and talk about myth vs. reality.
1) Symptoms are not recognized as cardiac arrest.
When women collapse, their symptoms are more likely to be interpreted as something like simple fainting or a seizure. This contributes to delays in initiating timely CPR (we only have a few minutes to save the brain). As mentioned earlier, women may have different or more subtle symptoms, so bystanders may assume a collapse is unlikely to be related to the heart stopping.
Bottom line: if someone collapses, you need to check for responsiveness, pulse, and breathing—and start CPR within minutes. Immediate bystander CPR can double chances of survival.
2) Delay in CPR and AED use.
Delays are related to concerns about inappropriate touching, hesitation to expose the chest and apply AED pads, and the fact that mannequins historically have been modeled on male anatomy.
a. Concerns about inappropriate touching
i. Ok, I get this—but if the person is not responsive, not breathing, and has no pulse (i.e., they are dying), it’s time to start CPR. The boobs can take it.
b. Exposing the chest
i. Again, I get this. Ideally you should be cutting or removing all clothing. AED kits usually have scissors, or you can even push the patient’s bra up toward the neck to get it out of the way. However… if you just cannot get past this, you can do chest compressions over a bra and you can apply AED pads on exposed skin even with an underwire bra, as long as the pads are not directly touching the bra or wire.
c. Mannequins
i. Revive Bend is proud to have a diverse group of mannequins for you and your group!
On this International Women’s Day, it is important to recognize that women (you, your mom, sister, daughter, wife, friend) are less likely to receive timely bystander CPR, less likely to have a bystander use an AED, less likely to survive a cardiac arrest, and—even if they do—less likely to recover neurologically intact.
If you already know how to perform CPR, keep these disparities in mind. And if you don’t—it’s time to learn.
Thanks for reading,
Susy
References
Cheng W, Liu J, Zhou C, Wang X. Factors analysis of lower probability of receiving bystander CPR in females: a web-based survey. BMC Cardiovasc Disord. 2025 Apr 8;25(1):270. doi: 10.1186/s12872-025-04709-5. PMID: 40200182; PMCID: PMC11977940.
Blewer AL, McGovern SK, Schmicker RH, May S, Morrison LJ, Aufderheide TP, Daya M, Idris AH, Callaway CW, Kudenchuk PJ, Vilke GM, Abella BS; Resuscitation Outcomes Consortium (ROC) Investigators. Gender Disparities Among Adult Recipients of Bystander Cardiopulmonary Resuscitation in the Public. Circ Cardiovasc Qual Outcomes. 2018 Aug;11(8):e004710. doi: 10.1161/CIRCOUTCOMES.118.004710. PMID: 30354377; PMCID: PMC6209113.
Kleinman ME, Buick JE, Huber N, Idris AH, Levy M, Morgan SG, Nassal MMJ, Neth MR, Norii T, Nunnally ME, Rodriguez AJ, Walsh BK, Drennan IR. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S448-S478. doi: 10.1161/CIR.0000000000001369. Epub 2025 Oct 22. PMID: 41122888.
Oving I, Blom MT, Tan HL. Sex differences in out-of-hospital cardiac arrest. Aging (Albany NY). 2020 Apr 3;12(7):5588-5589. doi: 10.18632/aging.102980. Epub 2020 Apr 3. PMID: 32244225; PMCID: PMC7185145.
