Arrhythmias in Female Patients: Incidence, Presentation and Management
Emily P. Zeitler, Jeanne E. Poole, Christine M. Albert, Sana M. Al-Khatib, Fatima Ali-Ahmed, Ulrika Birgersdotter-Green, Yong-Mei Cha, Mina K. Chung, Anne B. Curtis, Jodie L. Hurwitz, Rachel Lampert, Roopinder K. Sandhu, Fatima Shaik, Erin Sullivan, Kamala P. Tamirisa, Annabelle Santos Volgman, Jennifer M. Wright, Andrea M. Russo
Abstract
There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.