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American College of Cardiology

Clinical Articles, Lead Article

AF harder for women to live with

Atrial fibrillation (AF) feels worse for women, although men are more likely to die from the arrhythmia, according to a subanalysis of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT AF) registry presented recently at the American College of Cardiology (ACC) Scientific Sessions 2013.

Researchers led by Dr Jonathan Piccini, (Duke Clinical Research Institute, North Carolina, USA) found that women were more symptomatic with a poorer quality of life and greater functional limitations despite similar oral anticoagulation rates and less advanced AF than was seen in men.

However, mortality risk at one year was 41% more likely from any cause and 54% more likely from cardiovascular causes among men than among women in AF, both significant differences, the researchers reported.

Among the cohort of 10,126 patients with AF from a variety of USA practice settings analysed, 42% were women. Women in the cohort were a little older and more likely to have paroxysmal AF (54% versus 48% among men).

Baseline rhythm and rate control treatment was similar between groups, but several small differences had emerged by one year follow-up. Slightly fewer women were given cardioversion (5% versus 7%, p=0.0003) or catheter ablation (2% versus 3%, p=0.0084).

They also were less likely than men to take amiodarone (Cordarone, Pacerone, 7% versus 8%, p=0.01) or a beta-blocker (49% versus 50%, p=0.002) but more likely to get a calcium channel blocker (14% versus 11%, p<0.0001).

Symptoms more frequently reported by women than by men included:

  • Palpitations (40% versus 27%, p<0.0001)
  • Dyspnoea upon exertion (29% versus 27%, p=0.02) or rest (11% versus 9%, p=0.001)
  • Light-headedness (23% versus 19%, p<0.0001)
  • Fatigue (28% versus 25%, p<0.0001)
  • Chest discomfort (11% versus 8%, p<0.0001)
  • Their stroke risk was higher too, with CHADS2 scores of two or higher significantly more common than was seen for men (p<0.0001).

Oral anticoagulation in appropriate patients was equally likely between the sexes, but testing to make sure it was within the therapeutic range fell outside the recommended 30-day intervals somewhat less often for women than for men (20% versus 23%, p=0.002).

However, women spent more time outside the therapeutic range than men (35% versus 32%), with significantly more time at elevated risk from stroke from subtherapeutic levels as well as at elevated bleeding risk from supratherapeutic levels.

Women had a 24% higher risk of stroke, transient ischaemic attack, or systemic embolism at one year after adjustment for patient characteristics and site variability, but this difference was not statistically significant.

Cardiovascular mortality, though, was higher among men, with a rate of 2.20 deaths per 100 patient-years compared with 1.52 among women (p<0.0001).

All-cause mortality showed the same pattern (4.99 versus 4.14 per 100 patient-years, respectively (p<0.0001). Bleeding events, new onset heart failure, and first hospitalisations were no different between groups.

Quality of life, captured at one year in a subset of 2,005 patients, on the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scale, was lower among women overall (median 81 versus 88 among men, p<0.0001) and with regard to symptoms, daily activities, treatment concern, and treatment satisfaction.

Limitations of the study included voluntary participation by sites, the potential for residual and unmeasured confounding due to the observational design, and lack of power for stroke and other relatively uncommon events.

Reference

1. Piccini JP, et al. Quality of care, symptoms, and 1 year outcomes for women vs men with atrial fibrillation: primary results from the ORBIT-AF registry. ACC 2013; abstract 751–8.

Published on: March 27, 2013

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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