The Facts About Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP
by Patti J. Ryan, August 2015
Several studies have established that the symptoms and consequences of A-Fib are more profoundly felt in women.
Mother Nature and A-Fib Symptoms in Women
Females tend to develop A-Fib at a later age than men. They are also more likely to seek medical attention, are usually more symptomatic, and have higher heart rates. A-Fib tends to affect their physical quality of life more severely.
While men as a group develop A-Fib twice as often as women, there are twice as many females as males in the age group with the highest percentage of A-Fib.
Cardiovascular mortality rates are 2.5-fold greater for women with A-Fib. Women have a 4.6-fold higher rate of stroke. A-Fib is the most frequent cause of disabling stroke in elderly females.
Remember: you don’t have to live with A-Fib! Seek your cure.
What can you do about it? As a female with A-Fib, you may have more symptoms, quality of life issues and are at greater risk of an A-Fib-related stroke. But you don’t have to live with A-Fib. As soon as practical, get a referral to a heart rhythm specialist (a cardiologist with a specialty in electrophysiology). Early diagnosis means less damage to your heart and more treatment options.
Drug Therapies for Women with A-Fib and Risk of Stroke
Women fail more antiarrhythmic drugs therapies than men. Women don’t do well on some antiarrhythmic drugs (estrogen may prolong the QT interval).
Antiarrhythmic drug therapy in women with hypertension is associated with more major cardiovascular events. (Some research indicates that women may have more hypertension than men, 55.2% vs 40%).
What this means to patients: “Drugs don’t cure A-Fib but merely keep it at bay,” says heart rhythm specialist, Dr. Dhiraj Gupta. Antiarrhythmic drugs only work for about 50% of patients, and often stop working after a period of time. Many can’t tolerate the side effects.
Don’t spend a year in A-Fib trying different medications or combinations of medications only to find none work for you. In addition, anticoagulants, like warfarin, for your increased stroke risk, have their own health risks. Don’t live a life on medication. Seek your cure.
Differences in Catheter Ablation for Females with A-Fib
Women, in general, have smaller cardiac chambers so that catheter manipulation is more of a challenge (40.6 mm on average for women vs 44.6 mm for men). (However, since research data shows there is a significant delay in referral for ablation in women, it is feasible that they may have larger left atrial sizes due to remodeling, making this a moot point.)
Run, don’t walk to the best heart rhythm specialist (an electrophysiologist) you can find.
Females have more non-PV triggers and have lower ablation success rates.
Females tend to have more ablation complications like pericardial tamponade and vascular complications.
What can you do about it? Don’t delay. “Run, don’t walk” to the best heart rhythm specialist (an electrophysiologist) you can find, advises former A-Fib patient Sheri Weber. A-Fib is a progressive disease. Consult an EP after your diagnosis. Don’t wait for your A-Fib to get worse. (A-Fib rarely gets better.)
Gender Bias Also Plays a Role
Women are referred to A-Fib specialists three times less often than men. Men with A-Fib are managed more aggressively (such as more cardioversions) prior to seeking a catheter ablation.
Women often have developed a larger left atrium because of being referred to EPs later in their treatment plan than men (60 months for females vs 47 months for males).
Women are referred to A-Fib specialists three times less often than men.
Women are referred for catheter ablation less frequently and later into their treatment plan than men. When referred, they are older on average than men (61.6 years old vs 56.9 years old for men).
Consequently, they have more complex symptoms, and their procedure success rate is lower with more complications.
What can you do about it? When you go to your GP or cardiologist with your A-Fib symptoms or complaints, anticipate gender bias! Don’t let it deter you. A-Fib is a progressive disease. Don’t waste time. Don’t let your A-Fib worsen over time by remodeling or enlarging your heart. Request a referral to a heart rhythm specialist―an electrophysiologist (EP). Until you consult an EP, you may not be getting the best and most up-to-date A-Fib treatment advice. You deserve nothing less.
Don’t just take your meds and get used to being in A-Fib.
Why is there Gender Bias in the Treatment of Women with A-Fib?
In many cultures and societies, doctors are more conservative in their treatment of women with A-Fib. Some doctors, concerned with safety, may be reluctant to perform or recommend any invasive procedures in women.
Social and family pressures may delay medical consultation and treatment (“I can’t be sick. My family needs me.”) Access to health care may be limited for some women.
And, of course, there’s plain ol’ bias by male doctors against female patients. “Your symptoms are all in your mind.” or “Just take your meds and get used to being in A-Fib.” (These are actual quotes from A-Fib.com readers about their doctors’ advice.)
What can you do about it? Be prepared for your doctor appointment with a list of questions or concerns. Don’t leave until you have answers. Don’t be afraid to ‘fire’ your doctor. Get a second, or third opinion. Find a doctor who will partner with you to find your cure or best outcome. (For help, use the Finding the Right Doctor for You resources on A-Fib.com.)
Good News: EPs Less Likely to Have Gender Bias
Research indicates female gender bias tends to disappear when a woman sees an electrophysiologist (EP), particularly concerning catheter ablation. This suggests that treatment bias may be more at the primary care level, i.e., your GP or general cardiologist.
What this means to patients: It’s reassuring to be in the care of someone who regularly treats A-Fib patients. A-Fib is an electrical problem. Don’t waste you time. Don’t settle for just ‘managing’ your A-Fib. See a heart rhythm specialist, an electrophysiologist, a cardiologist who specializes in the electrical function of your heart. An EP will discuss all your treatment options. EPs want to free you from the burden of A-Fib.
About the author: Patti J. Ryan is editor of A-Fib.com and regularly contributes her writing and graphics expertise. She is also publisher of Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD (BeatYourA-Fib.com), an Amazon.com Top 100 Seller in two health-related categories.