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Device helps women with heart problems

Updated: September 24, 2012 6:25AM



Women account for more than half of all deaths from heart disease. They’re less likely to experience the classic symptoms of a heart attack, making timely diagnosis difficult. And studies have shown that women aren’t treated as aggressively as men after a heart attack or stroke.

Now, in a rare gender difference that favors women, a new study has found that women with mild or asymptomatic heart disease benefit more than men from a device that improves the heart’s pumping ability and corrects abnormal heart rhythms.

The device combines what’s known as cardiac resynchronization therapy with an implanted defibrillator. It was linked to a 70 percent reduction in heart failure in women, vs. a 35 percent reduction in men, researchers reported Monday in the Journal of the American College of Cardiology.

Women implanted with the combined cardiac resynchronization/defibrillation device — known as CRT-D — also saw a greater reduction in mortality after an average two years of follow-up than men who with the same device or a defibrillator alone.

Dr. Martha Gulati, a leading expert on heart disease in women who was not involved in the study, said the findings should serve as “a big wake-up call” to physicians that more women should be getting potentially life-saving resynchronization therapy.

“This is now really good evidence that this works in women, women need to get it and we need to knock out the idea that defibrillators don’t work as well in women,” said Gulati, of Ohio State University Medical Center.

Gulati cited a 2007 study in the Journal of the American Medical Association showing that while only about one-third of Americans eligible for defibrillators get them, women are implanted with the devices far less often than men.

The new study takes a closer look at data from 1,820 patients enrolled in a 2009 clinical trial comparing cardiac resynchronization with defibrillation to defibrillation alone.

Three factors appear to account for the “unexpected” finding that women respond better to resynchronization therapy than men, said study co-author Dr. Arthur J. Moss, a professor of medicine at the University of Rochester Medical Center.

One: Women are much more likely than men to have what’s known as non-ischemic cardiomyopathy, or heart disease not caused by blockages in the coronary arteries. Women in the study were also more likely to have a condition called left bundle branch block, which results in disorganized electrical activity throughout the heart.

Both of these conditions have been shown to respond well to cardiac resynchronization, which uses electrical impulses to make the bottom two chambers of the heart pump more efficiently.

The implanted defibrillator, meanwhile, monitors heart rhythm and delivers a shock to the heart if it beats irregularly.

A third factor is that women have smaller hearts than men.

“Patients with smaller hearts seem to get a better result from this type of electrical stimulation,” Moss said.

Gulati and Moss said future clinical trials need to include large enough numbers of women to tease out the types of gender differences observed in the study. Moss noted that 25 percent of the participants in his study were women, compared to the 5 percent included in most heart-device trials.

“The general feeling is that what’s good for men is good for women,” Moss said. “But there are certain situations where women get a better result, and that’s what we found.”



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