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Sex Differences in Atrial Fibrillation Outcomes
Study Questions:
Are there sex-based differences in symptoms, treatment, or outcomes of atrial fibrillation (AF)?
Methods:
This was an observational cohort study of 10,135 patients with AF who were enrolled in a nationwide registry (ORBIT-AF Registry) and seen in follow-up every 6 months. Quality of life (QoL) was measured with a 20-item survey designed for patients with AF. The outcomes of the study were mortality, cardiovascular death, hospitalizations, stroke/embolism, new-onset heart failure, and bleeding.
Results:
Men more often were asymptomatic compared to women (42.5% vs. 32.1%). Female sex was independently associated with a lower QoL score (odds ratio, 0.67). Compared to men, women less often had undergone cardioversion (26.7% vs. 32.4%) or AF ablation (4.9% vs. 5.9%). There were no significant differences in antiarrhythmic drug therapy, warfarin use, or time in therapeutic range. During a median follow-up of 2.3 years, women had a lower risk of mortality (hazard ratio [HR], 0.57) and cardiovascular death (HR, 0.56). However, after adjustment for other risk factors, women had a higher risk of stroke/embolism (HR, 1.39). Other outcomes did not differ significantly between men and women.
Conclusions:
Compared to men, women more often are symptomatic from AF and report a lower QoL. Women with AF have lower risk-adjusted mortality and cardiovascular death rates than men, but a higher rate of stroke/embolism.
Perspective:
After adjustment for other risk factors, female sex was associated with a 39% higher risk of stroke/embolism. This validates the use of female sex as a component of the CHA2DS2-VASc score.
Keywords: Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Electric Countershock, Embolism, Heart Failure, Outcome Assessment, Health Care, Quality of Life, Risk Factors, Sex Characteristics, Stroke, Warfarin
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