Gender-Related Differences in Rhythm Control Treatment in Persistent Atrial Fibrillation

Rienstra, Michiel; Veldhuisen, Dirk J. van; Hagens, Vincent E.; Ranchor, Adelita V.; Veeger, Nic J. G. M.; Crijns, Harry J.G.M.; Gelder, Isabelle C. Van; Investigators, Race

doi:10.1016/j.jacc.2005.05.078

Cited by 209 publications

(139 citation statements)

References 32 publications

(37 reference statements)

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“…Previous studies of AF have shown varying results, with no differences in cardiovascular morbidity and mortality between females and males, 7,8 lower all-cause and cardiovascular mortality in females compared with males, 9 or higher mortality in females compared with males. 10 In our study, no difference was seen in cardiovascular death/SSE between females and males.…”

Section: Discussionmentioning

confidence: 88%

Female Sex, Time in Therapeutic Range, and Clinical Outcomes in Atrial Fibrillation Patients Taking Warfarin

Senoo

Lip

2016

Stroke

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Background and Purpose-Female patients have higher risk for stroke than male patients in nonanticoagulated atrial fibrillation patients, but limited data are available on sex differences in stroke and bleeding outcomes among patients with anticoagulated atrial fibrillation on warfarin, especially in relation to quality of anticoagulation control, as reflected by the time in therapeutic range (TTR). Methods-We investigated adverse outcomes in females (n=791) and males (n=1501) Table). Cardiovascular death rates were 1.2% and 1.8%/100 patients-years, and SSE rates were 2.0% and 1.0%/100 patients-years, respectively. No differences were seen between females versus males for the end points of cardiovascular death (P=0.24) and SSE (P=0.25). For bleeding outcomes, any clinically relevant bleeding occurred in 78 females (11.3%/100 patients-years) and 173 males (13.2%/100 patients-years; P=0.11). Major bleeding occurred in 8 females and 31 males (1.1% and 2.3%/100 patients-years, respectively). Females had a lower risk of major bleeding than males (P=0.02). Sex, Age, and TTRThere were no significant differences in mortality and stroke outcomes between females and males in the prespecified age subgroups. Figure I in the online-only Data Supplement shows that females age ≥75 had lower rate of any clinically relevant bleeding (adjusted P=0.04) and females age <75 had a lower rate of major bleeding (P=0.04) compared with males.TTR was negatively correlated with any clinically relevant bleeding in females(r=−0.86; P=0.03) and males (r=−0.94; P=0.005; Figure). Because of the low number of events, we were limited in power to detect differences between females and males for the TTR<65% and TTR≥65% subgroups; however, numerically lower clinically relevant bleeding events were seen in females compared with males (TTR<65%: females 13.7% versus males 15.7%; TTR≥65%: females 6.6% versus males 9.8%; P value for interaction=0.44). Multivariate AnalysisFor the end point of combined cardiovascular death/SSE events, independent predictors on Cox regression analysis were age (hazard ratio [HR] On logistic regression analysis, determinants of poor TTR (TTR<65%) were previous coronary artery disease in both Figure.Correlation and regression analysis between time in therapeutic range and incidence of any clinically relevant bleeding by sex. CV indicates cardiovascular; SE, systemic embolism; and SSE, stroke/systemic embolism.by guest on May 9, 2018

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Section: Discussionmentioning

confidence: 88%

Female Sex, Time in Therapeutic Range, and Clinical Outcomes in Atrial Fibrillation Patients Taking Warfarin

Senoo

Lip

2016

Stroke

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“…These findings are similar to previous reports. 38,39 Other factors that were shown to be associated with higher AF prevalence in this cohort such as age, BMI, and some comorbid conditions (lung disease and renal failure) are also known risk factors for AF. 37,40 -42 In addition, therapy with neurohormonal modulators (ACEI, ARB, and β-blockers) and statins were protective against AF in this patient population.…”

Section: Comparison To Previous Registries and Reportsmentioning

confidence: 83%

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

El‐Chami

Brancato²,

Langberg

et al. 2010

Clinical Cardiology

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Background: QRSduration (QRSd) is associated with higher mortality and morbidity in patients with left ventricular (LV) dysfunction. The association between QRSd and atrial fibrillation (AF) has not been studied in this patient population. Objectives: To investigate the association between QRSd and AF in patients with LV dysfunction. Methods: Data were obtained from the National Registry to Advance Heart Health (ADVANCENT) registry, a prospective multicenter registry of patients with left ventricular ejection fraction (LVEF) ≤40%. A total of 25 268 patients from 106 centers in the United States, were enrolled between June 2003 and November 2004. Demographic and clinical characteristics of patients were collected from interviews and medical records. Results: Mean age was 66.3 ± 13 years, 71.5% were males, and 81.9% were white. A total of 14 452 (57.8%) patients had a QRSd <120 ms, 5304 (21.2%) had a QRSd between 120 and 150 ms, and 5269 (21%) had a QRSd >150 ms. Atrial fibrillation occurred in 20.9%, 27.5%, and 35.5% of patients in the QRS groups, respectively (P < 0.0001). After adjusting for potential AF risk factors (age, gender, race, body mass index, hypertension, diabetes, renal failure, cancer, lung disease, New York Heart Association [NYHA] class, ejection fraction, etiology of cardiomyopathy) and the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and lipid lowering drugs, QRS duration remained independently associated with AF (odds ratio: 1.20, 95% confidence interval: 1.14-1.25). Conclusion:In this large cohort of patients, QRSd was strongly associated with AF and therefore may predict the occurrence of this arrhythmia in patients with LV dysfunction. This association persisted after adjusting for disease severity, comorbid conditions, and the use of medications known to be protective against AF.

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“…23 Furthermore, in this study, women had a significantly smaller stroke volume with a higher heart rate, a finding similar to that in previous studies, which also reported that women have a higher heart rate, longer duration of paroxysmal AF, and more frequent recurrence of arrhythmia cardioversion. 24,25 Another possible factors are increased LV and arterial stiffness in women. Recent studies have reported that women display increased arterial and ventricular stiffening and deranged ventricular-arterial coupling compared with men, particularly with aging.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Yoshida

Obokata

Kurosawa

et al. 2016

Circ: Cardiovascular Imaging

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Background-Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS 2 score, CHA 2 DS 2 -VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. Methods and Results-LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS 2 score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA 2 DS 2 -VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain. Conclusions-Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women. (Circ Cardiovasc Imaging. 2016;9:e004999.

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Gender-Related Differences in Rhythm Control Treatment in Persistent Atrial Fibrillation

Abstract: In female patients with persistent AF, a rhythm control approach leads to more cardiovascular morbidity and mortality. Because treatment strategy did not influence QoL in female patients, a rate control approach may be considered in these patients.

Cited by 209 publications

References 32 publications

Female Sex, Time in Therapeutic Range, and Clinical Outcomes in Atrial Fibrillation Patients Taking Warfarin

Female Sex, Time in Therapeutic Range, and Clinical Outcomes in Atrial Fibrillation Patients Taking Warfarin

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

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