Atrial Fibrillation is a growing epidemic in Asia Pacific. A recent report by Biosense Webster, endorsed by the Asia Pacific Heart Rhythm Society (APHRS), has revealed a gender-based disparity in AFib. Women with AFib suffer a greater burden of disease in APAC and understanding the “why” is crucial in driving better patient outcomes for them. What can we do to better bridge this gap?
by Eisuke Yamamoto
7 out of 10 healthcare and social workers in the world are women. Women are the first to stand at the frontline of any health emergency response and play a crucial role as primary caregivers for children, the sick, and the elderly in their families and communities.1 Yet, when it comes to their own health, women face a higher burden of many health conditions. One such condition is Atrial Fibrillation or AFib. A recent Biosense Webster report, endorsed by the Asia Pacific Heart Rhythm Society (APHRS), highlighted how women with AFib in the Asia-Pacific are impacted disproportionately.
Atrial Fibrillation is the most common cardiac arrhythmia which is fast becoming one of the most significant health issues globally. In Asia Pacific specifically, over 1.4 million new cases are uncovered each year.2 Dubbed the “silent killer”, the condition can potentially lead to serious complications and impair one’s quality of life, if left undiagnosed and untreated. Given the rapidly ageing population in Asia Pacific, there has been a rising prevalence and incidence of AFib amongst women. This trend is expected to continue and by 2050, an estimated 23 million women in the region are estimated to suffer from AFib.3
While all AFib patients face health and lifestyle complications due to the disease, evidence shows that female patients face a disproportionate burden of the condition. One of the most significant examples is the detrimental effect on their quality of life. In a systematic review of 13 studies conducted in various geographies, it was reported that women experience more severe and debilitating symptoms, which leads to a greater symptom burden and a lower AFib-related quality of life.4 Furthermore, women performed worse in Atrial Fibrillation Effect on quality of life (AFEQT) scores comprising symptoms, daily activities, treatment concerns, and treatment satisfaction.
Such data tells us how grave the situation is, but it does not tell us why the experience for female patients is different. That is why we brought together a diverse panel of experts from eight geographic locations to discuss the unique features of AFib in women, while simultaneously conducting an analysis of existing studies.5 The insights shed light on critical issues stemming from the unmet needs of women with AFib.
Starting from innate biological differences, women have thinner atrial walls and smaller body sizes, which can lead to a higher risk of complications. The clinical profile of male and female patients with AFib differs in that female patients are typically older and more highly symptomatic, with more female than male patients requiring a pacemaker. Because of their older age, they are also likely to suffer from more comorbidities like diabetes or hypertension, which can complicate the way AFib is managed.6,7,8 Biological factors aside, there are many avoidable reasons that create gender inequality among those suffering from AFib, including:
- Challenge in diagnosis: In Asia Pacific, the condition presents differently in women, often making an accurate diagnosis more challenging for them. Experts in the study highlighted that women with AFib often show atypical symptoms, such as weakness rather than palpitations, chest tightness, or chest pain, but normal sinus rhythm, resulting in a delayed diagnosis.5
- Unconscious bias: Multiple studies have shown that women are less likely than men to be offered rhythm control treatments including anti-arrhythmic drugs, electrical cardioversions, and catheter ablation.9,10 There is an existing belief that female patients are frailer than male patients and thus unable to undergo invasive cardiac treatment. Thus, an unconscious bias among physicians in their management of patients of the opposite sex could play a role in how women are offered solutions to treat the condition, especially when female patients typically present at an older age. A systematic review and meta-analysis of 33 studies suggested that female physicians adopt a more partnership-building style and typically spend approximately 2.5 minutes longer with their patients per consultation, compared with their male counterparts.11 This additional time spent to build rapport and trust between patient and physician during consultations could potentially contribute positively to the decision-making process of patients.
- Differing decision-making process: The different approaches to spending time with men versus women patients suffering from AFib is critical because the decision-making process followed by women is different than the process followed by men. Studies show that women tend to be more averse to invasive treatment options, have a more prolonged decision-making process, and tend to de-prioritise their own care over their dependents’.5 Compared with men, women often seek more discussions with their family members and may spend a longer time pondering over the treatment options before coming to a decision. Prioritising their family’s needs over self-care also plays a critical role in their delayed decision-making.
- Lesser representation of women in clinical trials: The Asia-Pacific experts who contributed to the Biosense Webster whitepaper strongly recommended equitable gender inclusion in major clinical trials to evaluate gender-related differences. Because the percentage of men participating in clinical trials is much higher compared to women, understanding of the factors that impact women differently versus men is limited. Having more women from the Asia-Pacific participate in clinical trials will definitely help elevate the knowledge of the medical community, thus equipping them to offer solutions that cater specifically to women, eventually leading to an improvement in their quality of life.
- Poor health literacy: The experts who contributed to the paper also recommended improvement in the understanding of gender-related disparities in AFib epidemiology, presentation, and clinical course among the population, and the need to promote tailored, context-specific strategies for women. Improving understanding of the patient, family, culture, physician, and healthcare system factors that influence individual decision-making on AFib treatments is critical. This will help the medical community as well as the broader healthcare industry to develop strategies to address them positively.
MedTech’s Role in Addressing the Gender Disparity
The MedTech industry plays an important role in helping women suffering from AFib live the lives they want. As an industry, MedTech has traditionally focused on the procedure itself leading to transformational changes in core devices. To truly address the healthcare challenges faced by women suffering from AFib, we need to look at the entire patient pathway, to address their specific pain points.
From pre-diagnosis to interventional treatment to post-operation care, this could mean empowering physicians with the right innovation and research, educating patients, or collaborating with key stakeholders to improve access.
Driving innovation: MedTech has fast expanded to integrate AI and smart technologies into wearables like fitness trackers and biosensors. While these have enabled earlier detection of cardiac arrhythmia, clinical observations identified by experts in the report revealed several factors unique to women that the industry can address. From designing smaller wristbands for fitness trackers to fit smaller wrists, to improving the adhesiveness of sensors to counter the application of lotion. Such patient-centric changes could potentially improve monitoring and avoidance of misdiagnosis.
Empowering physicians: With physicians being the first point of contact for patients, it is crucial to ensure they are empowered with the right tools and solutions. As the global leader in the science and technology of cardiac arrhythmia treatment, Biosense Webster consistently partners with physicians to advance the treatment of cardiac arrhythmias by offering a range of innovations to identify, treat, and deliver care. This partnership includes commercial education solutions which highlight how the latest advancements in electrophysiology can drive treatment outcomes for patients regardless of gender, from precision mapping for improved accuracy of diagnosis to the effectiveness of catheter ablation.
Educating patients: Education also extends beyond healthcare professionals. We are also working closely with experts to shape the dialogue around AFib by creating better awareness among women and caregivers. With disease awareness programmes educating the public on common symptoms specific to women and improving understanding of treatment effectiveness and safety, female patients can seek earlier medical intervention and make informed decisions when it comes to treatment.
Advocating equality: Most importantly, MedTech companies have a huge role to play in championing equality at a broader level. By recommending gender inclusion in major clinical trials or observational studies to ensure proper patient representation, the healthcare community can better evaluate and understand gender-related differences. We can also advocate for equality by spearheading or participating in conversations with policymakers and governments to encourage reforms in healthcare systems to narrow the gap in access to treatment. In fact, experts have shared that economic barriers like payment schemes and insurance coverage have been an obstacle for patients in seeking better treatment options or even accessing digital technologies to help with monitoring.
By taking the first step with this expert panel, we have identified gaps in the patient journey, but this is just the beginning. The MedTech industry must come together to continue sharing knowledge, addressing unmet needs, and tailoring approaches to drive better patient outcomes. Through innovation, partnerships, and awareness, we will be able to facilitate equity for all patients with AFib, regardless of gender. [APBN]
About the Author
Vice President of Cardiovascular & Specialty Solutions Group (CSS), Asia Pacific, Johnson & Johnson MedTech
As the Vice President of Cardiovascular & Specialty Solutions Group (CSS) APAC at Johnson & Johnson MedTech, Eisuke is focused on driving the evolution of the cardiovascular healthcare to meet the needs of patients and healthcare professionals. Eisuke has also held several leadership roles across country marketing, sales management, and corporate strategy.