Differences and time trends in drug treatment of atrial fibrillation in men and women and doctors’ adherence to warfarin therapy recommendations

Carlsson, Axel C.; Wändell, Per; Sundquist, Kristina; Johansson, Sven‐Erik; Sundquist, Jan

doi:10.1007/s00228-012-1322-6

Cited by 28 publications

(22 citation statements)

References 29 publications

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“…These findings on the relationship between the bleeding score and VKA prescription are consistent with those of the UK cohort [5]. In the literature, evidence on the relationship between cardio-embolic scores and VKA prescription in real settings is not uniform [5,23,24]. In the present study, the cardioembolic risk was a predictor of VKA prescription, only after adjusting for the bleeding score or patient age.…”

Section: Discussionsupporting

confidence: 90%

Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation

Marcucci

Nobili

Tettamanti

et al. 2013

European Journal of Internal Medicine

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Background: Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. Methods: Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses. Results: At admission, among 543 patients the median scores (range) were: CHADS 2 2 (0-6), CHA 2 DS 2 -VASc 4 (1-9), HEMORR 2 HAGES 3 (0-7), HAS-BLED 2 (1-6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS 2 and HEMORR 2 HAGES, 98.3% combining CHA 2 DS 2 -VASc and HAS-BLED). 50-60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age. Conclusion: REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk.

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Section: Discussionsupporting

confidence: 90%

Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation

Marcucci

Nobili

Tettamanti

et al. 2013

European Journal of Internal Medicine

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“…[6][7][8][9] Shroff et al raised concern about a gender gap in prescription of warfarin among women, despite a paradoxically higher hazard of ischemic stroke. 14 In agreement with other studies 5,15,16 and in contrast with recent reports, 17 our female subjects were less frequently treated with OAC therapy. To this regard, aging in social isolation and cognitive decline have been reported as potential reasons, [18][19][20] but in our study advanced age was not independently related to non-prescription of OAC.…”

Section: Discussionsupporting

confidence: 93%

“…As previously reported, female subjects were older, had worse functional and cognitive conditions, and high rate of comorbidities. [3][4][5][6][7][8][9][10][11][12][13] It has been already reported that female patients have an increased risk of ischemic cardiovascular events, associated with AF. [6][7][8][9] Shroff et al raised concern about a gender gap in prescription of warfarin among women, despite a paradoxically higher hazard of ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…2 A rising number of papers analyze sexgender differences in treatment and mortality among patients with AF. [3][4][5] Women with AF seem to have an increased risk for cardiovascular events, including stroke [6][7][8][9] and underutilization of oral anticoagulant (OAC) treatment among women has been suggested to be a contributing factor. 10 The present study aimed to evaluate the sex-gender differences in Italian patients with AF enrolled in the large observational AntiThrombotic Agents in Atrial Fibrillation (ATA-AF) study.…”

Section: Introductionmentioning

confidence: 99%

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Sex-gender and atrial fibrillation treatment in the ATA-AF Study

Politi

Ciarambino

Riva³

et al. 2016

Ital J Med

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Atrial fibrillation (AF) is the most common cardiac arrhythmia. This analysis aimed to determine the sex-gender differences in patients with AF enrolled in the observational AntiThrombotic Agents in Atrial Fibrillation (ATA-AF) study. The study was conducted in 360 centers in Italy. During a 4-week period, all consecutive inpatients and outpatients aged ≥18 years, with a documented primary or secondary diagnosis of AF, were included. A total of 7148 patients (47% females) were enrolled. Females were significantly older, they more frequently needed assistance and were affected by severe cognitive impairment. The preferred anti-arrhythmic strategy in both genders was heart rate control (females: 54.7%, males: 48.4%, P<0.0001). Among non-valvular AF patients (n=4845, females=2139), females displayed greater prevalence of CHA 2 DS 2 -VASc ≥2 (96.1% vs 80.7%; P<0.0001) and CHADS 2 ≥2 (68.2% vs 60.4%; P<0.0001). More females were at high risk of bleeding (31.3% vs 26.1%; P<0.0001). Oral anticoagulants (OAC) were used in 55.5% of non-valvular AF patients, less frequently in females (50.9% vs 59.2%; P<0.0001). High hemorrhagic risk [odds ratio (OR) 5.94, 95% confidence interval (CI) 4.70-7.51], paroxysmal AF (OR 3.88, 95% CI 3.11-4.83), cognitive (OR 2.18, 95% CI 1.57-3.02) and functional impairment (OR 1.31, 95% CI 1.02-1.67) were significantly related with non-prescription of OAC, while age >75 was not (1.00, 95% CI 0.79-1.26). This study defines sex-gender differences in AF patients, including lower OAC prescription in females despite of higher thrombotic risk. Concomitant higher hemorrhagic risk and other characteristics that were more frequent in females (i.e., severe cognitive and functional impairment) may at least partly explain this trend towards gender-related under-prescription of OAC.

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“…22 A rising number of papers analyze sex-gender differences in treatment and mortality among patients with AF. 23 Women with AF seem to have an increased risk for cardiovascular events, including stroke 24 and underutilization of oral anticoagulant (OAC) treatment among women has been suggested to be a contributing factor. 25 However, studies have reported significant gender differences in the anti-arrhythmic strategy.…”

mentioning

confidence: 99%

Young FADOI and gender medicine: sex gender differences in cardiovascular disease

Ciarambino

Gino

Gnerre³

et al. 2018

Ital J Med

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IntroductionBernardine Healy, in an editorial of 1991 on the NEJ The Yentl Syndrome, 1,2 showed how cardiovascular disease in women is understudied, under diagnosed and undertreated. The adverse ischemic heart disease is leading cause of death, less common in young women, where myocardial infarction (MI) mortality is two-fold higher in women younger than 50 years compared with age-matched men. The literature suggests that when women look like men, with male-pattern obstructive cardiovascular diseases (CHD), they are more likely to be diagnosed and treated like men. Two new analyses suggest that the Yentl syndrome is alive and well 10 years later. The first event in women takes about 10-20 years later than men. Women are more likely than men to have highrisk presentations and less likely to manifest central chest pain. 1,3 Pain in the upper back, arm, neck, and jaw, as well as unusual fatigue, dyspnea, indigestion, nausea/vomiting, palpitations, weakness, and a sense of dread, occur more frequently in women compared with men. The absence of chest pain or silent heart attack is more common in women than in men (35% vs 28%). So, women often turn later to the doctor and are treated less aggressively.1 Cardiovascular disease is the most common cause of death and hospitalization in worldwide. Recognition of important gender differences plays an important role in cardiovascular disease prevention. New sensitivity about gender differences, and particularly attention among women, will be necessary for more analytic view about cardiovascular disease in both sexes. Possible causesThe Framingham study already described the risk factors for CHD in women; then the INTERHEART, conducted in 52 countries around the world, identified nine risk factors, measurable and modifiable. These factors measurable and modifiable are: i) smoking; ii) hypertension; iii) diabetes; iv) dyslipidemia; v) abdominal obesity (waist/hip ratio); vi) stress and psychosocial factors; vii) physical inactivity; viii) low intake of fruits and vegetables; ix) alcohol. More risk factors greatly multiply the probability of infarction. 4,5 These risk factors explain more than 90% of myocardial infarctions and in about 96% of CHD in women. For example, in women, it has been shown that family and marital stress increase the risk of Young FADOI and gender medicine: sex gender differences in cardiovascular disease ABSTRACTWe have evaluated gender-related differences in cardiovascular disease. In particular, in coronary heart disease, atrial fibrillation, arterial hypertension, venous thromboembolism and diabetes mellitus. ©Copyright T. Ciarambino et al., 2018 Licensee PAGEPress, Italy Italian Journal of Medicine 2018 12:23-31 doi:10.4081/itjm.2018.864 Italian Journal of Medicine 2018; volume 12:23-31 N o n -c o m m e r c i a l u s e o n l y ischemic heart disease. In women there is another condition that simulates the coronary heart disease. This condition is the Takotsubo syndrome. [6][7][8][9][10][11][12][13][14][15][16] Depression is one aspect of psycho...

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Differences and time trends in drug treatment of atrial fibrillation in men and women and doctors’ adherence to warfarin therapy recommendations

Abstract: Pharmacotherapy of AF has improved over time, though CHADS2 guidelines need to be implemented systematically in primary health care in Sweden to decrease the risk of stroke and improve quality of life in patients with AF.

Cited by 28 publications

References 29 publications

Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation

Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation

Sex-gender and atrial fibrillation treatment in the ATA-AF Study

Young FADOI and gender medicine: sex gender differences in cardiovascular disease

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