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(Circulation. 2001;103:2365.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
New-Onset Atrial Fibrillation
Sex Differences in Presentation, Treatment, and Outcome
From the Centre for Health Evaluation and Outcome Sciences (K.H.H.), Vancouver, BC; the Division of Cardiology (C.R.K., J.A.B.), University of British Columbia, Vancouver; the Division of Cardiology (S.J.C.), McMaster University, Hamilton, Ontario; the Division of Cardiology (G.K.), University of Western Ontario, London; the Ottawa Heart Institute (M.G.), Ottawa, Ontario; the Division of Cardiology (R.S.), University of Calgary, Calgary, Alberta; the Montreal Heart Institute (M.T.), Montreal, Quebec; and the Division of Cardiology (P.D., D.N.), St Michael’s Hospital, Toronto, Ontario, Canada.
Correspondence to Karin H. Humphries, DSc, CHEOS-St Paul’s Hospital, 620B–1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6. E-mail karinh{at}cheos.ubc.ca
Background—Although sex differences in coronary artery disease have received considerable attention, few studies have dealt with sex differences in the most common sustained cardiac arrhythmia, atrial fibrillation (AF). Differences in presentation and clinical course may dictate different approaches to detection and management. We sought to examine sex-related differences in presentation, treatment, and outcome in patients presenting with new-onset AF.
Methods and Results—The Canadian Registry of Atrial Fibrillation (CARAF) enrolled subjects at the time of first ECG-confirmed diagnosis of AF. Participants were followed at 3 months, at 1 year, and annually thereafter. Treatment was at the discretion of the patients’ physicians and was not directed by CARAF investigators. Baseline and follow-up data collection included a detailed medical history, clinical, ECG, and echocardiographic measures, medication history, and therapeutic interventions. Three hundred thirty-nine women and 560 men were followed for 4.14±1.39 years. Compared with men, women were older at the time of presentation, more likely to seek medical advice because of symptoms, and experienced significantly higher heart rates during AF. Compared with older men, older women were half as likely to receive warfarin and twice as likely to receive acetylsalicylic acid. Compared with men on warfarin, women on warfarin were 3.35 times more likely to experience a major bleed.
Conclusions—Anticoagulants are underused in older women with AF relative to older men with AF, despite comparable risk profiles. Women receiving warfarin have a significantly higher risk of major bleeding, suggesting the need for careful monitoring of anticoagulant intensity in women.
Key Words: fibrillation • sex • anticoagulants
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