ACC 2013 Report – AF feels worse for women

Atrial fibrillation feels worse for women, although men are more likely to die from the arrhythmia, a sub-analysis of the ORBIT AF registry showed.

Women were more symptomatic with a poorer quality of life and greater functional limitations despite similar oral anticoagulation rates and less advanced Afib than was seen in men, Jonathan Piccini, MD, of the Duke Clinical Research Institute, and colleagues found.

However, mortality risk at 1 year was 41% more likely from any cause and 54% more likely from cardiovascular causes among men than among women in atrial fibrillation, both significant differences, the researchers reported here at the American College of Cardiology meeting.

“When we see a female patient, it’s really important to understand that they’re at high risk for symptomatic Afib, pay careful attention to it, and spend a lot of time reviewing their symptoms to make sure that we’re appropriately treating not just the risk of stroke but also their symptoms,” Jonathan Piccini explained.

His group analyzed the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT AF) by gender.

Among the cohort of 10,126 patients with atrial fibrillation from a variety of U.S. practice settings, 42% were women.

Women in the cohort were a little older and more likely to have paroxysmal Afib (54% versus 48% among men).

Baseline rhythm and rate control treatment was similar between groups, but several small differences had emerged by 1 year follow-up.

Slightly fewer women got cardioversion (5% versus 7%, P=0.0003) or catheter ablation (2% versus 3%, P=0.0084).

They also were less likely than men to take amiodarone (7% versus 8%,P=0.01) or a beta-blocker (49% versus 50%, P=0.002) but more likely to get a calcium channel blocker (14% versus 11%, P<0.0001).

Symptoms more frequently reported by women than by men included:

• Palpitations (40% versus 27%, P<0.0001)
• Dyspnea upon exertion (29% versus 27%, P=0.02) or rest (11% versus 9%, P=0.001)
• Light-headedness (23% versus 19%, P<0.0001)
• Fatigue (28% versus 25%, P<0.0001)
• Chest discomfort (11% versus 8%, P<0.0001)

Their stroke risk was higher too, with CHADS₂ scores of 2 or higher significantly more common than was seen for men (P<0.0001).

Oral anticoagulation in appropriate patients was equally likely between the sexes, but testing to make sure it was within the therapeutic range fell outside the recommended 30-day intervals somewhat less often for women than for men (20% versus 23%, P=0.002).

However, women spent more time outside the therapeutic range than men (35% versus 32%), with significantly more time at elevated risk from stroke from sub-therapeutic levels as well as at elevated bleeding risk from supra-therapeutic levels.

“That’s something we need to investigate, because, really, with more frequent testing they should have been the patients with better time in therapeutic range,” Piccini said.

Women had a 24% higher risk of stroke, transient ischemic attack, or systemic embolism at 1 year after adjustment for patient characteristics and site variability, but this difference was not statistically significant.

Cardiovascular mortality, though, was higher among men, with a rate of 2.20 deaths per 100 patient-years compared with 1.52 among women (P<0.0001).

All-cause mortality showed the same pattern (4.99 versus 4.14 per 100 patient-years, respectively(P<0.0001).

Bleeding events, new onset heart failure, and first hospitalizations were no different between groups.

Quality of life, captured at 1 year in a subset of 2,005 patients, on the Atrial Fibrillation Effect on Quality-of-Life scale, was lower among women overall (median 81 versus 88 among men,P<0.0001) and with regard to symptoms, daily activities, treatment concern, and treatment satisfaction.

Limitations of the study included voluntary participation by sites, the potential for residual and unmeasured confounding due to the observational design, and lack of power for stroke and other relatively uncommon events.

ORBIT AF was funded by Janssen.

Piccini reported consulting fees or honoraria from Johnson & Johnson, Medtronic, Forest Laboratories, BMS/Pfizer, and Spectranetics as well as grant funds from Johnson & Johnson.

Reference: 

Piccini JP, et al “Quality of care, symptoms, and 1 year outcomes for women vs men with atrial fibrillation: Primary results from the ORBIT-AF Registry” ACC 2013; Abstract 751-8.