Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial

Abstract

To analyze the clinical profile and therapeutic strategy in atrial fibrillation (AF) according to gender in a contemporaneous patient cohort a prospective, multicenter observational study was performed on consecutive patients diagnosed with AF and assessed by cardiology units in the region of Galicia (Spain). A total of 1007 patients were included, of which 32.3% were women. The mean age of the women was significantly greater than that of the men (71.6 versus 65.7 years; p < 0.001), with a higher prevalence of hypertension (HTN) and valve disease. Women more often reported symptoms related to arrhythmia (28.2% in EHRA class I versus 36.4% in men), with a poorer level of symptoms (EHRA classes IIb and III). Thromboembolic risk was significantly higher among women (CHA2DS2-VASc 3 ± 1.3 versus 2 ± 1.5), in the same way as bleeding risk (HAS-BLED 0.83 ± 0.78 versus 0.64 ± 0.78) (p < 0.001), and women more often received anticoagulation therapy (94.1% versus 87.6%; p = 0.001). Rhythm control strategies proved significantly less frequent in women (55.8% versus 66.6%; p = 0.001), with a lesser electrical cardioversion (ECV) rate (18.4% versus 27.3%; p = 0.002). Perceived health status was poorer in women. Women were older and presented greater comorbidity than men, with a greater thromboembolic and bleeding risk. Likewise, rhythm control strategies were less frequent than in men, despite the fact that women had poorer perceived quality of life and were more symptomatic.

Antiarrhythmic drugs for pharmacological cardioversion of atrial fibrillation and sex differences: Insights from the CANT II Study

“…Notably, as this study enrolled consecutive patients without exclusion criteria, one should underline the slight predominance of men represented in the registry. These observations are consistent with former reports, which documented a significantly diverse profile of female patients suffering from AF [15,16]. In the Euro Observational Research Programme (EORP) pilot survey on AF performed on 3119 patients, women with AF had a similar profile to our findings, including older age, higher European Heart Rhythm Association class, higher estimated risk of systemic embolism reflected by higher CHA 2 DS 2 -VASc score, and more common chronic use of anticoagulation [16].…”

“…On the other hand, Duran-Bobin et al [15] showed similar tendencies, including a lower prevalence of chronic treatment with AADs in females than in males (31.3% vs. 42.3%, P = 0.001). Still, they did not provide data on use of AADs for pharmacological cardioversion [15]. In our study, the body mass index and prevalence of obesity were comparable between women and men (Table 1).…”

“…Still, the EORP study did not provide detailed information on the efficacy and mode of pharmacological cardioversion [16]. On the other hand, Duran-Bobin et al [15] showed similar tendencies, including a lower prevalence of chronic treatment with AADs in females than in males (31.3% vs. 42.3%, P = 0.001). Still, they did not provide data on use of AADs for pharmacological cardioversion [15].…”

Gender-Based Clinical, Therapeutic Strategies and Prognosis Differences in Atrial Fibrillation

“…This fact was also confirmed by Rienstra et al [16], who concluded that patients with asymptomatic AF were more often men. Another recent study [17] found, as in our study, that rhythm control strategies were less frequent than in men, even though women had poorer perceived quality of life and were more symptomatic.…”