Women and atrial fibrillation

Volgman, Annabelle Santos; Benjamin, Emelia J.; Curtis, Anne B.; Fang, Margaret C.; Lindley, Kathryn J.; Naccarelli, Gerald V.; Pepine, Carl J.; Quesada, Odayme; Vaseghi, Marmar; Waldo, Albert L.; Wenger, Nanette K.; Russo, Andrea M.

doi:10.1111/jce.14838

Cited by 56 publications

(50 citation statements)

References 150 publications

(345 reference statements)

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“…A review recommends a gendered management strategy in treating AF, as the gender differences in AF are substantial, and antiarrhythmic drugs and ablation can have more complications in females than in males [ 30 ]. However, both the 2020 ESC Guidelines and a recent review recommend that females and males are offered diagnostic assessment and therapies equally [ 6 , 33 ]. It is difficult to conclude on gender differences in risk and benefit of different treatment strategies in AF patients, as females are significantly underrepresented in studies on AF [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study

et al. 2022

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Background The aim of this study was to analyse whether there are patient related or geographic differences in the use of catheter ablation among atrial fibrillation patients in Norway. Methods National population-based data on individual level of all Norwegians aged 25 to 75 diagnosed with atrial fibrillation from 2008 to 2017 were used to study the proportion treated with catheter ablation. Survival analysis, by Cox regression with attained age as time scale, separately by gender, was applied to examine the associations between ablation probability and educational level, income level, place of residence, and follow-up time. Results Substantial socioeconomic and geographic variation was documented. Atrial fibrillation patients with high level of education and high income were more frequently treated with ablation, and the education effect increased with increasing age. Patients living in the referral area of St. Olavs Hospital Trust had around three times as high ablation rates as patients living in the referral area of Finnmark Hospital Trust. Conclusions Differences in health literacy, patient preference and demands are probably important causes of socioeconomic variation, and studies on how socioeconomic status influences the choice of treatment are warranted. Some of the geographic variation may reflect differences in ablation capacity. However, geographic variation related to differences in clinical practice and provider preferences implies a need for clearer guidelines, both at the specialist level and at the referring level.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study

et al. 2022

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“…Atrial fibrillation in women has different characteristics than AF in men with respect to response to treatment, stroke risk, and clinical outcomes. 33 , 34 However, the difference in underlying pathogenesis of AF in women and men has not been fully elucidated. A previous report suggested that estrogen can have a protective benefit against AF, which was shown by substantially less shortening of the effective refractory period in response to rapid pacing in premenopausal women than postmenopausal women or men.…”

Section: Discussionmentioning

confidence: 99%

Association of Depression With Atrial Fibrillation in South Korean Adults

Lee

Han

et al. 2022

JAMA Netw Open

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IMPORTANCEThe risk of atrial fibrillation (AF) in people with depression is not fully known.Depression is associated with sympathetic activation and emotional stress, which might increase the risk of new-onset AF.OBJECTIVE To assess the incidence of new-onset AF in those with and without depression using data from a nationwide health care database. DESIGN, SETTING, AND PARTICIPANTSThis cohort study obtained data from the Korean National Health Insurance Service database and enrolled people who underwent a nationwide health checkup in 2009. People younger than 20 years and those with a history of heart valve surgery, previous diagnosis of mitral stenosis, or who were diagnosed with AF between January 1, 2002 and December 31, 2008 were excluded. The risk of new-onset AF (occurring between 2009 and 2018) was compared in people who were and were not diagnosed with depression within a year before the 2009 nationwide health checkup. Data were analyzed between August 1, 2020 and October 31, 2020. EXPOSURE Previous diagnosis of depression. MAIN OUTCOMES AND MEASURES Cumulative incidence and risk of new-onset AF between 2009and 2018 in participants with and without depression. Kaplan-Meier analysis was conducted to assess incidence of AF, and Cox proportional hazards regression was used to calculate adjusted and unadjusted hazard ratios (HRs) and 95% CIs. RESULTSA total of 5 031 222 individuals with a mean (SD) age of 46.99 (14.06) years (2 771 785 men [55.1%]) were included in the analysis; of these individuals, 148 882 (3.0%) had a diagnosis of depression in the year before the 2009 health checkup and 4 882 340 (97%) did not. People with depression vs those without depression were older (aged 56.7 vs 46.7 years) and more likely to be women (96 472 [64.8%] vs 2 162 965 [44.3%]). Prevalence of hypertension, diabetes, dyslipidemia, and heart failure was higher in the depression group. The cumulative incidence of new-onset AF was significantly higher in people with depression vs without depression in the Kaplan-Meier analysis and showed steady divergence throughout 10 years of follow-up (cumulative incidence, 4.44% vs 1.92%; log-rank P < .001). After adjusting for covariates, depression was associated with a 25.1% increased risk of new-onset AF (HR, 1.25; 95% CI, 1.22-1.29; P < .001). People with recurrent episodes of depression showed even higher risk of new-onset AF (HR, 1.32; 95% CI, 1.27-1.37; P < .001). Young age and female sex had significant interactions with depression, which suggests that young people and women with depression may have an increased risk of new-onset AF.CONCLUSIONS AND RELEVANCE This study found that depression was associated with a significantly increased cumulative incidence and risk of new-onset AF. Recurrent episodes of (continued) Key Points Question Is depression associated with increased risk of new-onset atrial fibrillation (AF)? Findings In this cohort study of 5 031 222 individuals with a follow-up of 43 115 042 person-years, depression was associated with a higher cumulative incidence of ...

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“…It has been well established that female patients with NVAF are older and more susceptible to stroke than male patients ( 4 , 5 ). Female gender is related to higher mortality and poorer long-term outcome after stroke attack ( 1 , 6 ). Functional outcomes at discharge and 6 months after stroke attack are significantly worse in female patients ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Women with NVAF are generally older than men, with a higher stroke rate. They also have worse long-term outcomes after the stroke attack ( 1 ). Despite their higher stroke risk, women are less likely to be treated with anticoagulation therapy ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Efficacy and Safety After Left Atrial Appendage Closure: A 4.3-Year Follow-Up Analysis

Chen

Zhang

et al. 2022

Front. Cardiovasc. Med.

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IntroductionWomen are related to higher stroke risk and poorer outcome after stroke attack in patients with non-valvular atrial fibrillation (NVAF). The sex differences in efficacy and safety after left atrial appendage closure (LAAC) have remained elusive. This retrospective study aimed to investigate the safety, feasibility, and clinical outcomes of LAAC between women and men.MethodsFrom 2014 to 2018, 395 patients who underwent LAAC in our center were enrolled in this retrospective study. Baseline clinical characteristics, procedural parameters, and postoperative follow-up data were collected and compared between women and men.ResultsThe study included 154 women and 241 men. Compared with men, women were older (68.1 ± 7.9 vs. 64.6 ± 8.8, p < 0.01**), with higher CHA2DS2-VASc score (4.0 ± 1.7 vs. 3.0 ± 1.6, p < 0.01**). During the mean follow-up duration of 1,566 days (4.3 years), there were 39 major adverse cardiovascular events (MACE, including 19 cardiovascular or unexplained deaths, 15 ischemic strokes, and 5 major bleedings) recorded in 34 patients. The overall rate of ischemic stroke was 0.9 per 100 patient-years, and the overall rate of MACE was 2.1 per 100 patient-years. The cardiovascular or unexplained death and major bleeding were comparable between women and men. Compared with men, women had lower rates of ischemic stroke, fatal or disabling ischemic stroke, MACE, and fatal or disabling MACE, but none of them reached statistical differences (HR: 0.361, p = 0.099, HR: 0.429, p = 0.276, HR: 0.600, p = 0.170, and HR: 0.621, p = 0.254, respectively). In the adjusted analyses with multivariate Cox regression models, women had a lower fatal or disabling ischemic stroke rate compared with men (HR: 0.100, p = 0.041).ConclusionLeft atrial appendage closure was feasible and safe for patients of both genders. The ischemic stroke, cardiovascular or unexplained death, and major bleeding were comparable between women and men. However, women were the independent protective factors against fatal or disabling ischemic stroke after LAAC implantation.

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Women and atrial fibrillation

Cited by 56 publications

References 150 publications

Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study

Socioeconomic and geographic differences in ablation of atrial fibrillation in Norway - a national cohort study

Association of Depression With Atrial Fibrillation in South Korean Adults

Sex Differences in Efficacy and Safety After Left Atrial Appendage Closure: A 4.3-Year Follow-Up Analysis

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