Broken Links: Gender Disparities Across the Chain of Survival in Out‐Of‐Hospital Cardiac Arrest

Keywords

automated external defibrillator, bystander CPR, cardiopulmonary resuscitation, chain of survival, gender disparities, health equity, out-of-hospital cardiac arrest, resuscitation training, women

Abstract

Aim(s)

To examine gender-based disparities across each link of the American Heart Association's Chain of Survival for women experiencing out-of-hospital cardiac arrest, highlighting systemic, cultural and educational barriers that compromise equitable outcomes.

Design

A discursive review synthesizing epidemiological studies, public health data and qualitative research on cardiac arrest and gender disparities.

Methods

A comprehensive search of databases including PubMed and CINAHL identified studies on gender differences in out-of-hospital cardiac arrest recognition, bystander intervention, emergency response and post-arrest care. Literature was critically analyzed using constant comparative analysis and organized according to the five links of the American Heart Association's Chain of Survival to identify recurring themes and evidence of disparity.

Results

Significant disparities were identified at every link in the Chain of Survival. Women are less likely to have cardiac symptoms recognized, receive bystander cardiopulmonary resuscitation or defibrillation and experience timely or guideline-concordant advanced life support and post-resuscitation care. Contributing factors include implicit bias, underrepresentation of women in resuscitation training materials and social norms that hinder rapid intervention.

Conclusion

Gender disparities in cardiac arrest survival are systemic and multifactorial, resulting in ‘broken links’ across emergency response systems, public perceptions and healthcare education. Addressing these inequities requires reforms in public education, resuscitation training and clinical protocols that prioritize gender-sensitive and inclusive care.

Implications for the Profession and/or Patient Care

Nurses, as educators, advocates and caregivers, are uniquely positioned to drive transformational change in emergency and cardiac care. By championing women-centered and gender-sensitive resuscitation education, implementing inclusive practices and addressing intersectional barriers, nurses can help ensure equitable, responsive and just care. Advancing these priorities is essential for improving survival and neurological outcomes for women and advancing health equity in global healthcare.

Original Publication Citation

Rasmussen, R., and A. Watson. 2026. “ Broken Links: Gender Disparities Across the Chain of Survival in Out-Of-Hospital Cardiac Arrest.” Journal of Advanced Nursing 1–13. https://doi.org/10.1111/jan.70658.

Document Type

Peer-Reviewed Article

Publication Date

2026-06-01

Publisher

Journal of Advanced Nursing, Wiley

Language

English

College

Nursing

Department

Nursing

University Standing at Time of Publication

Assistant Professor

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