Arrhythmias in women : diagnosis and management

297 Pages·2014·10.75 MB·English

by  Yong-Mei Cha, Margaret A. Lloyd, Ulrika M. Birgersdotter-Green

ARRHYTHMIAS IN WOMEN
Diagnosis and Management
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ARRHYTHMIAS
IN WOMEN
Diagnosis and Management
- -
editors in chief
Yong-Mei Cha, MD
Consultant and Co-Director, Implantable Cardiac Device Service,
Division of Cardiovascular Diseases
Mayo Clinic, Rochester, Minnesota
Professor of Medicine
Mayo Clinic College of Medicine
Margaret A. Lloyd, MD, MBA
Consultant, Division of Cardiovascular Diseases
Mayo Clinic, Rochester, Minnesota
Assistant Professor of Medicine
Mayo Clinic College of Medicine
Ulrika M. Birgersdotter-Green, MD
Director, Pacemaker and ICD Services
UC–San Diego Health Sciences, San Diego, California
Professor of Medicine
UC–San Diego School of Medicine
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Arrhythmias in women : diagnosis and management / edited by Yong-Mei Cha, Margaret A. Lloyd,
Ulrika M. Birgersdotter-Green.
p. ; cm.—(Mayo Clinic scientific press)
Includes bibliographical references.
ISBN 978–0–19–932197–1 (alk. paper)
I. Cha, Yong-Mei, editor of compilation. II. Lloyd, Margaret A., editor of compilation. III. Birgersdotter-Green, Ulrika M.,
editor of compilation. IV. Series: Mayo Clinic scientific press (Series)
[DNLM: 1. Arrhythmias, Cardiac—diagnosis. 2. Arrhythmias, Cardiac—therapy. 3. Women’s Health. WG 330]
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With this book, the editors wish to honor Doris J. W. Escher, MD, Nora F. Goldschlager, MD,
Anne B. Curtis, MD, and Anne M. Gillis, MD—past presidents of the North American Society of
Pacing and Electrophysiology and its successor, the Heart Rhythm Society—who have provided
inspirational leadership with integrity, compassion, and good cheer.

Foreword
SEX MATTERS
Sex matters—more and differently than was ever believed, especially as it relates
to cardiovascular disease. But the fact that sex should be considered when car-
ing for patients with arrhythmias is a relatively new concept and one for which
there is a substantial gap between its recognition and the realization of health
benefits. The Institute of Medicine in its landmark 2001 report, Exploring the
Biological Contributions to Human Health: Does Sex Matter?, answered its own
question with a resounding yes; sex must be taken into consideration “from womb
to tomb” when it comes to the science of medicine and caring for women and
men. Evidence of important sex differences affecting every aspect of cardiovascu-
lar disease is mounting, and arrhythmias are no exception. Aside from the obvi-
ous differences associated with gonadal hormones, differences in natural history,
symptoms, accuracy of diagnostic tests, response to therapy, prevalence and rela-
tive risk of risk factors, and social and behavioral issues have been identified, each
of which has the potential to impact treatment and outcomes.
Therein is the challenge. While discoveries and advances in the diagnosis and
treatment of heart disease have come at apparent lightning speed over the past few
decades, compared with men, women have not experienced the same decrease
in cardiovascular mortality, and until the past decade, they were largely ignored
as a population worthy of separate study or consideration. Previously, women
and their physicians were told that heart disease did not develop in women, or
vii
viii FOREWORD
if it did, it did not develop until women were elderly. When and if women ulti-
mately received a diagnosis of heart disease, it was not felt to be as serious a health
threat as it was in men. Women’s symptoms are sometimes challenging to address,
and both women and their physicians can be quick to attribute manifestations
of cardiovascular disease to menopause, mental health issues, or aging. In stud-
ies of several arrhythmias and related conditions, compared with men, women
have received a diagnosis and treatment at a more advanced stage of disease and
received delayed or less-intensive therapy. These practices have likely contributed
to women’s higher cardiovascular-related total mortality.
Compounding these historical practices, physicians and patients have been
faced with insufficient sex-specific scientific evidence to confidently manage
women with cardiac arrhythmias. The lack of relevant cardiovascular research
on women and inadequate enrollment of women in clinical trials, compounded
by the absence of sex-specific data analysis or reporting, have led to a substan-
tial and persistent sex-based knowledge gap in care for women with suspected or
diagnosed arrhythmias. These care and knowledge gaps include key issues such
as symptoms and the effects, side effects, risks, and benefits of commonly used
diagnostic tests and therapies.
Without sex-specific evidence to guide them, clinicians are left with the
option of either withholding therapies from women when there is no sex-specific
proof of benefit, or alternatively, treating women in a “sex-blind” manner using
data from studies on men as a means to guide their treatment. Neither approach
is evidence-based, and both have the potential for harm, overtreatment, or
undertreatment.
While cardiac arrhythmias continue to be responsible for substantial morbid-
ity and mortality in women, progress is being made. Over the past decade there
has been exponential growth in the availability of evidence-based and sex-specific
data and strategies for optimal arrhythmia diagnosis, risk assessment and modifi-
cation, and clinical management. Many of these discoveries have informed impor-
tant changes in recommended practice and have affirmed the need for a sex-based
approach to arrhythmia management in order to optimize practice and outcomes
for women.
An important next step in bridging the sex gap in care is to provide to medical
practitioners and the women they care for a practical, comprehensive, and acces-
sible source of this new information. For that reason, I celebrate the publication
Foreword ix
of this superb textbook, in which the very experts who have made the most sig-
nificant contributions to the field of electrophysiology in women synthesize their
knowledge into a practical work that will be a valuable reference for anyone who
provides medical care to women. On behalf of women who are living with or are
at risk for heart disease, I wish to thank the editors and authors for providing this
resource to the health care community.
Sharonne N. Hayes, MD
Consultant, Division of Cardiovascular Diseases
Founder, Women’s Heart Clinic
Professor of Medicine, Mayo Clinic College of Medicine
Mayo Clinic, Rochester Minnesota