Pamela S. Douglas, MD; Lesley H. Curtis, PhD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-3038.
Requests for Single Reprints: Pamela S. Douglas, MD, Duke University Medical Center, 7022 North Pavilion, Box 17969, Durham, NC 27715; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Douglas: Duke University Medical Center, 7022 North Pavilion, Box 17969, Durham, NC 27715.
Dr. Curtis: Duke University Medical Center, 6046 North Pavilion, Box 17969, Durham, NC 27715
Douglas P., Curtis L.; Is Biology Destiny or Can We Optimize Care for All Patients?. Ann Intern Med. 2012;156:241-242. doi: 10.7326/0003-4819-156-3-201202070-00015
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Published: Ann Intern Med. 2012;156(3):241-242.
Women are often underrepresented in randomized, controlled trials, yet they make up a substantial proportion of patients seen in practice. A one-size-fits-all approach ignores the underlying biological differences between men and women and sometimes results in excess mortality for female patients (1). In such cases, the lack of generalizable data on treatment efficacy makes the practice of evidence-based medicine in individual patients more challenging. Against this background, the validity of applying a one-size-fits-all approach to the use of implantable cardioverter-defibrillators (ICDs) deserves careful evaluation.
Ample evidence indicates sex-related differences in the epidemiology of sudden death and in the underlying biology of cardiac arrhythmias (2-4). However, the pivotal randomized trials supporting the use of ICDs for primary and secondary prevention included few women (5-8) and were underpowered for the rare, post hoc, sex-specific analyses of outcomes. These factors, along with the well-documented underuse of ICD therapy in real-world settings (9-10), make it difficult to fully assess the value of ICDs in women.
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Cardiology, Rhythm Disorders and Devices, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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