A treatment that helps regulate heartbeats works much better in women then men, though it isn’t offered to women nearly as much, says a study in JAMA Internal Medicine.

Based on a 2010 report from a national implantable defibrillator registry, there were approximately 100,000 cardiac resynchronization therapy defibrillator (CRT-D) installations that year in the United States, and about 28,000 were in women.

CRT-Ds make the two walls of the heart pump at nearly the same time, addressing a problem called left bundle branch block (LBBB).

According to current guidelines, the top recommendation for CRT-D is in patients with a LBBB and a QRS duration of 150 milliseconds or longer. QRS duration is the time for electrical activation of the heart, represented by the large wave on an ECG recording.

CRT-Ds led to a 60% reduction in heart failure or death in women, according to researchers at the Food and Drug Administration. It reduces women’s risk of death alone by 55%.

For men, it’s a different story, reducing the risk of heart failure or death by 26% and death alone by 15%.

In women with a QRS of 130 to 149 milliseconds, CRT-D reduced their risk of heart failure or death by 76%. Men saw no benefit.

“This is important because recent guidelines limit the class I indication [highest recommendation] for CRT-D to patients with LBBB and QRS of 150 milliseconds or longer. While guidelines do give a class IIa to patients with LBBB and a QRS of 120 to 149 milliseconds, the present findings are important to communicate because women are less likely to receive CRT-D than men are,” the study states.

It may simply come down to physiological differences, says David G. Strauss, MD, PhD, the study’s corresponding author.

“The fact that women normally have smaller heart ventricles and shorter QRS duration than men provides an anatomical and physiological explanation for the findings, but the higher rate of nonischemic heart failure in women compared with men may have also contributed,” says Strauss.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.