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

Abstract

Background Catheter ablation improves symptoms and quality of life in patients with atrial fibrillation (AF); however, despite its benefit, women are less likely than men to undergo catheter ablation. Women with AF have been described to have more frequent and severe symptoms with a lower quality of life than men, and it is therefore unclear why women are less likely to undergo catheter ablation. We prospectively characterized gender differences in AF symptoms among men and women undergoing ablation at UNC using questionnaire data. Methods Functional capacity was assessed with the Duke Activity Status Index (DASI) and quality of life was assessed with the Canadian Cardiovascular Society Symptoms of AF score (CCS‐SAF) and the AF Effect on Quality‐of‐Life Questionnaire Tool (AFEQT). Results Among 191 patients in the study, women were less likely to undergo catheter ablation and had higher rates of paroxysmal AF and higher CHADS2‐VASc scores than men. Women had a worse functional capacity with significantly lower DASI scores than men; quality of life was also worse among women, with higher CCS‐SAF scores and lower AFEQT scores than men. After adjustment for AF type, there was a persistent gender difference for functional capacity and symptom measures. Conclusions At the time of catheter ablation, women with AF had a significantly lower functional status with worse symptoms and a lower quality of life than men. The role of this symptom difference on the gender gap in enrollment for catheter ablation is unclear and likely due to multiple patient and provider factors.

Gender and age differences in symptoms and health‐related quality of life in patients with atrial fibrillation referred for catheter ablation

“…However, most of these studies have used generic questionnaires and these are influenced not only by the arrhythmia but also by other causes, for example, concomitant diseases . In two recent studies, disease‐specific questionnaires were used confirming previously reported gender differences.…”

“…The reasons suggested range from socioeconomic factors to fundamental gender differences regarding perception of illness . Bazemore et al made use of disease‐specific questionnaires but merely states that “this gender gap in enrolment for catheter ablation is unclear and likely due to multiple patient and provider factors.” Walters et al evaluated symptom severity and HRQoL also with disease‐specific instruments and found that psychological factors outweighed clinical predictors …”

“…3,4,7 Bazemore et al made use of disease-specific questionnaires but merely states that "this gender gap in enrolment for catheter ablation is unclear and likely due to multiple patient and provider factors." 6 Walters et al evaluated symptom severity and HRQoL also with disease-specific instruments and found that psychological factors outweighed clinical predictors. 16 The main finding that older patients report a more severe impact on HRQoL, particularly on the physical subscale, is not surprising.…”

“…Studies exploring patients’ experiences from a gender and age perspective have shown considerable differences between women and men, as well as an impact of age in regard to the effect of arrhythmia on symptoms and HRQoL. There are studies with data from AF‐specific questionnaires, those who have made use of generic and domain‐specific questionnaires and those using a combination of questionnaires . Generic and domain‐specific questionnaires allow for comparisons between patients with different diagnoses while the advantage with a disease‐specific is that it adds specific, disease‐related information …”

“…There are studies with data from AF-specific questionnaires, those who have made use of generic and domain-specific questionnaires and those using a combination of questionnaires. [3][4][5][6] Generic and domain-specific questionnaires allow for comparisons between patients with different diagnoses while the advantage with a disease-specific is that it adds specific, diseaserelated information. [7][8][9] The importance of identifying valid disease-specific questionnaires to assess HRQoL is highlighted in the guideline document from 2015 and if not available, it is recommended to develop and validate such a questionnaire.…”