Women less likely to get implantable heart devices

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With a growing, aging population, doctors are seeing more heart failure patients than ever before.

Implantable heart devices such as pacemakers, defibrillators and cardiac resynchronization therapy are helping these patients live regular lives.

But a study at the Cleveland Clinic has found that women were 30 percent less likely than men to receive an implantable device.

“The data from our study showed that the survival benefit from defibrillator therapy was absolutely identical for men and women,” explains Niraj Varma, MD.

The survival rate for women who received cardiac resynchronization therapy was 30 percent better than men. So why are women not getting these life-saving treatments?

"It’s been known for a long time that women are generally underrepresented in clinical trials,” Varma explains.

Less representation in trials means fewer treatment options for women. Varma also says that women are not referred as much for these devices as compared to men, and heart failure in women may present itself differently than in men.

“Each step of the way, there’s a potential roadblock to women finally coming and receiving a device from us. So this is an issue,” Varma says.

It's an issue that he believes can be solved if both doctors and patients identify and characterize the sex differences between men and women with these devices so that the therapy can be more precise.

Varma also says it’s important for women to be more open with their doctors. Women are more likely than men to have heart attack symptoms unrelated to chest pain. They may experience neck, jaw, shoulder, upper back or abdominal pain.

REPORT #2538

BACKGROUND: In medicine, men have long ruled. From the animals used in drug trials (overwhelmingly male) to the patients enrolled in clinical trials (predominantly male) to the guidelines for diagnosis and treatment (mostly based on men), a man's biology has been the guiding force for decades. The result is that women have at times been misdiagnosed and even harmed, because tests, dosages, symptoms and treatments for major diseases have long been based on what medical schools and medical research still consider the archetypal patient: the 154-pound white male. Although significant social progress has been made over recent years, the application of the principles behind the legislation to women's health and gender-based research has not been so positive. Those who research gender issues in clinical and laboratory medicine are aware of significant barriers both for researchers and for subjects entering studies. For example, research funding for coronary artery disease in men is far greater than for women, yet the at risk population of women, which is an older age group, suffers more morbidity and mortality. Clinical research also exhibits gender bias in other areas. One of these is in recruitment into clinical trials and another is the reporting of gender-related data.
(Source: https://www.aarp.org/health/conditions-treatments/info-2016/womens-health-gender-bias-cs.html and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761670/#!po=2.27273)

WHAT DO PATIENTS THINK?: Women report doctors being condescending or not taking symptoms seriously. Sometimes women say they are told their symptoms are all in their head. A 2011 Institute of Medicine report on the public health impact of chronic pain found that not only did women seem to suffer more often from pain, but they also had a higher pain tolerance. Another report including 2,400 women conducted by the National Pain Report concluded that 90 percent of women with chronic pain feel the healthcare system discriminates against women. Amiee Lesko of Pennsylvania, shared, “My PCP is a woman, been seeing her for 10ish years. She’s younger and the absolute best. She takes time to listen and never discounts any of my thoughts, feelings, or complaints. I totally trust her opinion. When I had a health scare in 2015, I had seen a handful of physicians, all male. They all brushed my complaints off as ‘mental’ since they couldn’t see anything. I basically felt like brushed off as a ‘silly girl.’ Now when I’m looking for a specialist, I always try to find a female provider first.”
(Source: https://www.huffingtonpost.com/entry/is-there-a-gender-bias-against-female-pain-patients_us_589b6b3ee4b061551b3e06ab)

ON THE HORIZON: Thanks to urging by the federal government, as well as more inclusive research, medicine is beginning to look at the different ways men and women react to drugs and diseases. Researchers now know that every cell in our bodies has a gender, says Mary-Lou Pardue, a Massachusetts Institute of Technology biologist who produced a landmark report on these issues. There are sex differences in liver metabolism, kidney function, hormonal influences and stomach enzymes, to name a few. That means that women and men metabolize drugs differently, experience different side effects and derive different benefits from the same treatments. Even something as common as taking a low-dose aspirin for heart attack prevention. In women, it raises the risk for stomach bleeding and is better at reducing the risk for stroke than preventing a first heart attack. In men, it's the reverse. It’s better for preventing a first heart attack, not so good for preventing a stroke. There has been other unveiling about gender differences through a growing body of research in four major diseases: heart disease, cancer, diabetes and stroke.
(Source: https://www.aarp.org/health/conditions-treatments/info-2016/womens-health-gender-bias-cs.html)