Why Women Face Delayed Arrhythmia Diagnoses: Lindsey Valenzuela, PharmD

Women with arrhythmia are too often overlooked—not because their symptoms are absent, but because they look different.

Lindsey Valenzuela, PharmD, APh, BCACP, vice president of population health integration at Desert Oasis Healthcare, spoke with The American Journal of Managed Care^®(AJMC^®) about the clinical and structural barriers that delay arrhythmia detection and treatment in women. She explained how limited female participation in trials leads to a lack of identifying symptoms that may differ from men, and how unequal access to advanced therapies like ablation and implantable cardioverter-defibrillators (ICDs) perpetuates disparities.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Women often present with atypical symptoms of arrhythmia, which can delay diagnosis and treatment. What are some of the biggest clinical and equity gaps in arrhythmia detection and management for women?

Yeah, women definitely have atypical or less-recognized symptoms, and that can often lead to delays in diagnosis. Things like fatigue, anxiety, GI [gastrointestinal] symptoms, vague palpitations—sometimes those reported to a primary care physician take time to really decide what the origin of those symptoms are.

Part of this might also be because women are underrepresented in clinical trials and device studies, which means that the evidence can be weaker or sex-agnostic, and also pregnancy and lactation exclusions can lower this representation further. I mean, even when you read areas like the American Heart Association, much of what we know about sex-specific cardiovascular outcomes is really from secondary analysis.

We're sort of behind already on understanding arrhythmias in women, but we do know that cardiovascular function is really highly impacted by hormones. And of course, this is tricky as women go through a series of changes throughout their lives related to hormones, and understanding that impact on the cardiovascular system really does stall a lot of providers in getting them to that next level of specialty care. And women, once they get to specialty care, are often less likely to receive interventions like ablations or ICDs.

I read an article in JAMA recently that was looking at the different demographics of people receiving ICDs with similar diagnosis, and the article showed that women and Black patients were less likely to receive an ICD while meeting the same criteria as White men.¹ So, when you look at why women maybe haven't been detected, there's a myriad of different confluences of reasons, but they are really delayed in getting those diagnoses.

References

1. Hernandez AF, Fonarow GC, Liang L, et al. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA. 2007;298(13):1525-1532. doi:10.1001/jama.298.13.1525