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  • The results, published in the journal Resuscitation Plus, show that women have fewer shockable rhythms, lower survival and different causes of death than those observed in men.
  • The research, within the framework of the Registry of Cardiac Arrests and Sudden Death of Catalonia (RAIMCAT), has been developed by the SEM in collaboration with the Institute of Legal Medicine and Forensic Sciences of Catalonia, the Biomedical Research Institute of Catalonia South (IRB CatSud), the Sant Joan University Hospital of Reus, the Rovira i Virgili University, among other institutions.

A study led by the Medical Emergency System of Catalonia (SEM), in collaboration with the Institute of Legal Medicine and Forensic Sciences of the Department of Justice and Democratic Quality, the Biomedical Research Institute of Southern Catalonia (IRB CatSud), the Sant Joan University Hospital in Reus, the Rovira i Virgili University, the Polytechnic University of Catalonia, the IDIAP Jordi Gol and other Catalan institutions, concludes that the survival of women after sudden cardiac death is approximately half that recorded in men.

The research, recently published in the scientific journal Resuscitation Plus , concludes that women not only survive less frequently after sudden cardiac death, but also present a different clinical profile compared to men that can condition prevention, treatment and survival.

The differences affect aspects as diverse as the age at which the episode occurs, the initial heart rhythms, the causes that originate the cardiac arrest and some clinical history that may play a relevant role during the assessment and treatment of patients.

The study, carried out within the framework of the Registry of Cardiac Arrests and Sudden Death of Catalonia ( RAIMCAT ), analysed 639 cases of sudden cardiac death occurring between 2014 and 2017, 191 of which were women, 29.9% of the total. The results show a survival rate of 4.2% in women compared to 9.9% in men. The study also concludes that women presented fewer shockable rhythms —cardiac arrest rhythms in which the application of an electric shock with a defibrillator is indicated— than men (21% compared to 36%) and received fewer resuscitation attempts.

These results indicate that sudden cardiac death is not a homogeneous pathology and that incorporating the gender perspective can contribute to improving both prevention and diagnostic and therapeutic strategies.

“Sudden cardiac death does not manifest itself in the same way in women and men. Understanding these differences is essential to adapt preventive strategies, care protocols and increase the chances of survival,” highlights Dr. Youcef Azeli from the Medical Emergency System and principal investigator of the study.

A differentiated clinical profile

The analysis of 639 cases of sudden cardiac death shows a lower incidence in women. However, their probability of survival is significantly lower than that of men, approximately half.

The study highlights that women reach the episode of sudden death with different characteristics. On average, they are older than men when sudden death occurs (74 years compared to 66 years), they have less frequent shockable rhythms – those that offer a greater chance of success with early defibrillation – and they suffer certain causes of death at a higher rate.

Among these causes, pulmonary embolism stands out, which is more than four times more frequent in women than in men (13.3% compared to 3%). There is also a higher burden of psychiatric disorders than in men (15% compared to 9%), a higher history of alcohol consumption (25% compared to 16%), and a higher presence of antidepressants (11% compared to 2%).

Implications for clinical practice

The authors emphasize that pulmonary embolism may be underdiagnosed in women during resuscitation, which limits the use of thrombolytic treatment at the time of arrest. The study also emphasizes the need for closer cardiovascular monitoring using electrocardiograms, especially to monitor the QT interval, in women on psychotropic drug treatment, especially if they also consume alcohol.

About the study

The study has been led by the Medical Emergency System of Catalonia (SEM), with the Institute of Legal Medicine and Forensic Sciences of Catalonia as the main scientific partner, and has had the collaboration of the Biomedical Research Institute of Southern Catalonia (IRB CatSud), the Sant Joan University Hospital of Reus, the Rovira i Virgili University, the Polytechnic University of Catalonia (UPC), the IDIAP Jordi Gol and other institutions.

The research is part of the Registry of Cardiac Arrests and Sudden Death of Catalonia (RAIMCAT), which integrates healthcare data from the SEM, hospital clinical information, data from judicial autopsies and the primary care network. This approach allows us to reconstruct the complete process of sudden cardiac death and obtain a unique perspective in Europe and much more globally.

Bibliographic reference

Azeli Y., Barbería E., Solà-Muñoz S., Landín I., Fernández A., Rey-Reñones C., García-Gual C., Gomez-Tortosa A., Granado-Font E., Fernández-Sender L., García-Vilana S., Bonet G., Jiménez-Fàbrega X., Bardají A.

In Spain, 17,241 sudden cardiac deaths are recorded every year

The incidence of sudden cardiac death (SCD) in the Mediterranean area is one third lower than in countries in northern Europe and America. This is the conclusion of a study co‑led by the Pere Virgili Health Research Institute (IISPV) and the Catalan Medical Emergency System (SEM), with the participation of the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), Joan XXIII University Hospital of Tarragona, Sant Joan University Hospital of Reus, Xarxa Santa Tecla, IDIAP Jordi Gol, Rovira i Virgili University, and the Catalan Health Institute. The study, recently published in the international journal BMJ Global Health, analyses the factors that explain the lower impact of sudden cardiac death in the Mediterranean region.

According to the study (Epidemiology of sudden cardiac arrest in the western Mediterranean area based on a prospective registry), 70% of sudden deaths are caused by cardiac conditions. Chronic coronary disease is identified as the main cause of sudden death, followed by acute coronary disease and cardiomyopathies. In addition, 15% of sudden deaths are due to non‑cardiac cardiovascular causes, such as pulmonary thromboembolism or intracranial haemorrhage. The remaining 15% are related to non‑cardiovascular causes, such as digestive bleeding or infections. Alfredo Bardají, cardiologist at Joan XXIII University Hospital, highlights that “this study found that acute myocardial infarction as a cause of sudden cardiac death is decreasing, thanks to improvements in early treatment”.

Regarding the possible prevention of sudden death, Youcef Azeli, principal investigator of the study, SEM doctor, physician at Sant Joan University Hospital of Reus and head of the IISPV research group in emergencies, explains that “only one third of patients have a previous history of heart disease, which makes prediction difficult. Also, in 50% of cases, cardiac arrest occurs without previous symptoms, which makes treatment harder”. Even so, the study shows that one in five patients had a medical consultation in the four weeks before the event, which highlights the need to work on medium‑term prevention strategies to improve the detection of patients at risk.

This research is also relevant for two additional reasons. First, it involved up to six institutions, which made it possible to gather information from many different sources. In this regard, the participation of the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), part of the Department of Justice and Democratic Quality, is especially important. Its director, Eneko Barbería, points out that “including forensic analyses and data allows us to obtain a complete picture of sudden cardiac death and makes this study unique in the Mediterranean area and in Europe”.

Second, this is the first study that provides real data on the incidence of sudden death in Catalonia and Spain, thanks to the wide participation of institutions that contributed information. According to the Catalonia Cardiac Arrest and Sudden Death Registry (RAIMCAT), 2,700 cases are recorded every year in Catalonia and initially attended by SEM, which means 7 cases per day. In Spain as a whole, the annual number is 17,241 cases, or 47 cases per day. This study, unique in Europe, shows that sudden cardiac death is one of the most important causes of death in Spain, just after lung cancer.

The survival rate after sudden cardiac arrest is only 10%. Cases with previous chest pain or where an automated external defibrillator (AED) is used before SEM arrives have a better chance of survival. For this reason, in the presence of warning signs such as chest pain, or when witnessing a sudden loss of consciousness, it is essential to recognise the situation quickly, start high‑quality chest compressions, and use an AED as soon as possible.

This study, funded by the Catalan Resuscitation Council (CCR), has made it possible to identify the cause of death in a higher percentage of cases than other published studies. Research like this, with high‑quality registries on sudden cardiac death, helps advance precision medicine, prevention, and treatments that improve patient care.

Reference: Azeli, Y., Barbería, E., Solà-Muñoz, S., Landín, I., Fernández, A., Rey-Reñones, C., García-Gual, C., Gomez-Tortosa, A., Granado-Font, E., Fernandez-Sender, L., García-Vilana, S., Bonet, G., Jimènez-Fàbrega, X., & Bardaji, A. (2025). Epidemiology of sudden cardiac arrest in the western Mediterranean area based on a prospective registry. BMJ global health, 10(11), e020462. https://doi.org/10.1136/bmjgh-2025-020462