Women’s Subtle Arrhythmia Symptoms Are Often Overlooked: Svetlana Barbarash, MD

Women with arrhythmias are still slipping through the cracks of diagnosis, according to Svetlana Barbarash, MD, chief of Cardiology and noninvasive cardiologist at Southwest Medical.

In an interview with The American Journal of Managed Care® (AJMC®), she noted that many women present with symptoms like fatigue, shortness of breath, or vague discomfort that are easily dismissed or mistaken for noncardiac issues. These subtle signs, she said, mask clinically significant arrhythmias, especially in women with obesity, hypertension, or diabetes.

Barbarash also highlighted the growing role of digital monitoring tools, multidisciplinary follow-up, and value-based care strategies to improve early detection and access.

This transcript has been lightly edited for clarity and conciseness.

Svetlana Barbarash, MD | Image credit: Southwest Medical

AJMC: What are the most common signs of arrhythmia you see in women, and how do they differ from what’s typically seen in men?

Barbarash: The most common presentation of arrhythmia in women would be palpitations. However, women are known to present with atypical symptoms such as shortness of breath and fatigue. It's common not just for arrhythmia, but for coronary artery disease and angina, so that may be also atypical presentation in women. That also applies to arrhythmia. Women may have more vague symptoms that would not necessarily signal as arrhythmia when a provider interviews a woman patient.

It is more likely to have arrhythmia behind the symptoms of palpitations and fatigue and shortness of breath if a presenting female patient has comorbidities such as obesity, hypertension, or diabetes. A lot of times we have a healthy young woman come in for evaluations of palpitations and nonspecific symptoms, and we just end up giving them reassurance after normal workup. But women with more comorbidities have more specific diagnoses of atrial fibrillation and such if they present with the symptoms.

AJMC: What predictive technologies or digital monitoring tools are currently available, and how can using these improve early detection of arrhythmias?

Barbarash: There are 2 different types of technologies. One is something that is patient-owned, such as Apple watches and other devices like pads. I've seen a lot of use of a device called AliveCor, and that's something that patients can purchase if it’s inexpensive. It is something that they have at their fingertips—if they have any symptoms, they can just push the button and put their fingers on the pad and document it.

The other devices that are available at the provider offices, they can be wearable devices such as heart monitors, patches, or event monitors, or there are also implantable devices called loop recorders that can be implanted in the patient and stay there for a long period of time and have a more continuous monitoring of arrhythmia.

AJMC: In your experience, what elements of team-based or coordinated care are most effective in improving education and follow-up for patients with newly detected arrhythmias?

Barbarash: I think what is very helpful is for the patients to have access to multidisciplinary teams of nurses and pharmacists, sleep apnea physicians, and anticoagulation clinics. It’s important to have education before hospital discharge and early involvement of cardiologists for newly-diagnosed atrial fibrillation, for example, for cardioversion, medications, and risk factors assessment, and ultimate ablation if the patient prefers. It’s a complex management that goes from the initial detection to the follow-up and assessment of the best treatment strategies.

AJMC: Inconsistent insurance coverage is cited as a major barrier to preventive care and screening. How can value-based care models help reduce this barrier for patients and improve arrhythmia outcomes?

Barbarash: With value-based care, I think supporting programs such as telemedicine or promoting patient navigators or home monitoring devices, and then incentivizing the practices for implementation of guideline-directed medical therapy—such as, in this particular situation, anticoagulation for atrial fibrillation—I think that will help patients to get access and to be treated properly.