Atrial fibrillation in women: treatment

Abstract

Sex-specific differences in the epidemiology, pathophysiology, presentation, prognosis, and treatment of atrial fibrillation (AF) are increasingly recognized. Women with AF generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. Effective treatment of the arrhythmia in women is critical to reduce the rate of adverse events. We review the current evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy. In addition, we provide a critical evaluation of potential disparities and biases in health-care use that may be associated with differences in the outcomes between women and men.We underscore current knowledge gaps that need to be addressed in future studies to improve the management of AF in women. In particular, we suggest several strategies to produce quality evidence from randomized, clinical trials for women with AF.

Gender differences in symptoms and functional status in patients with atrial fibrillation undergoing catheter ablation

“…However, despite its benefit, evidence suggests that women with AF are disproportionately less likely to receive catheter ablation than men. For example, large randomized studies of catheter ablation enrolled much fewer women than men, and meta‐analyses of outcomes for catheter ablation in patients with AF have described male predominance as high as 90% . This gender gap in catheter ablation is redemonstrated among registry data, including a worldwide survey of 8,745 patients with AF undergoing catheter ablation among 90 centers, for which 63.8% of subjects were male .…”

“…For example, large randomized studies of catheter ablation enrolled much fewer women than men, 4 and meta-analyses of outcomes for catheter ablation in patients with AF have described male predominance as high as 90%. [5][6][7] This gender gap in catheter ablation is redemonstrated among registry data, including a worldwide survey of 8,745 patients with AF undergoing catheter ablation among 90 centers, for which 63.8% of subjects were male. 8 Similarly, analysis of 511,958 patients with AF from the PINNACLE Registry showed that male gender is a predictor for rhythm control strategy, including catheter ablation.…”

Cause-Specific Mortality in Patients with Chronic Kidney Disease and Atrial Fibrillation

“…Multiple mechanisms have been proposed to address these differences including the role of estrogen replacement therapy [39]. While some suggested a lower risk of AF with hormone replacement therapy, others have refuted those findings [40,41].…”

Individual and monitoring centre influences upon anticoagulation control of AF patients on warfarin: A longitudinal multi‐centre UK‐based study

“…Anticoagulated female AF patients show a slightly higher rate of ischaemic stroke than male patients, even after adjusting for TTR, suggesting the potential of a higher net clinical benefit of anticoagulant treatment in females, which is not being achieved. The greater risk of ischaemic stroke in women, in part related to females spending more time outside and below the therapeutic range than men, suggests that they might benefit from a more aggressive VKA management, or anticoagulation with a NOAC, as these drugs have similar efficacy and bleeding risk in women and men …”

“…The greater risk of ischaemic stroke in women, in part related to females spending more time outside and below the therapeutic range than men, 9,22 suggests that they might benefit from a more aggressive VKA management, or anticoagulation with a NOAC, as these drugs have similar efficacy and bleeding risk in women and men. 23 The variability of cTTR is remarkable: a meta-analysis reported a range from 40% to 78% in US-based primary studies 24 and even in randomised controlled trials variability ranged from 44% to 77%. 25 This is important as the benefit from the VKA oral anticoagulants is dependent upon TTR.…”