Bridging the gender gap in atrial fibrillation

Abstract

Women have a similar lifetime prevalence of non-valvular atrial fibrillation (NVAF) compared with that of men. Given the significant morbidity and potential mortality associated with NVAF, it is crucial to understand gender differences with NVAF. Women can be more symptomatic than men. Despite a higher baseline stroke risk, they are less likely to be on anticoagulation. Women have a greater risk of thromboembolism and a similar rate of bleeding risk compared with men on anticoagulation. Initial experience suggests that novel oral anticoagulants have similar safety and efficacy profile in men and women. Although women can have more adverse reactions from antiarrhythmic therapies, they are often referred later than men for ablation. As a group, a mitigating factor in ablation referral is that women also have a higher incidence of procedural complications from catheter ablation. This review summarizes the available literature highlighting significant gender-based differences and also highlights areas for research to improve NVAF outcomes in women.

Epidemiology, diagnosis, and management of atrial fibrillation in women

“…Cardioversion to normal sinus rhythm is equally successful in women and men; however, women were less likely to undergo electric cardioversion than men 29. In addition, women were less likely to undergo catheter ablation and, when this procedure is performed, they are older and with larger left atrial dimension 102,103…”

Atrial fibrillation and exercise in women: some answers given, some questions remain

“…Women have a higher age of AF onset, a greater risk of embolic stroke, a poorer quality of life, a higher heart rate during AF, more adverse effects to antiarrhythmic drugs, a different pattern of AF trigger localisation and differences in how the autonomic nerve system modulates cardiac electrophysiology 6. Thus, it is reasonable to assume that also the cardiac response to physical activity may differ between the genders.…”

Determining If Sex Bias Exists in Human Surgical Clinical Research

“…However, the US Government Accountability Office performed an assessment of adverse events by sex and reported that 8 of 10 drugs removed from the market by the FDA were because of adverse events in women . Males and females have dissimilar health issues, metabolize and react to some drugs differently, respond to medical devices differently, and can have diverse outcomes after medical interventions …”