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Alrabadi N, Al-Nusair M, Haddad R, Alghizzawi BS, Al-Nusair N, Alhaj Mohammad S, Shteiwi SM, El-Zubi MK, Marie Z, Alnsour A, Jarrah M, Alzoubi KH, Hammoudeh A. Sex differences in clinical features, utilization of oral anticoagulant agents, and 1-year outcome in Middle Eastern patients with atrial fibrillation. Curr Med Res Opin 2024; 40:745-752. [PMID: 38507072 DOI: 10.1080/03007995.2024.2332440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Studies have revealed that sex can predict differences in multiple aspects of atrial fibrillation (AF). These differences are underreported in the Middle East. This study aims to describe sex-specific differences in risk factors, symptomatology, management, and outcomes in Middle Eastern patients with AF. METHODS The JoFib (Jordan-Atrial-Fibrillation) study is an observational, prospective, multicenter, nationwide registry in AF. Comparisons were made between female and male patients using Pearson chi-square and Mann-Whitney U tests. Multivariable regression models were constructed to investigate whether the female sex was predictive of any AF-related outcomes (all-cause death, cardiovascular death, ischemic stroke or systemic embolism [IS/SE], major bleeding, and clinically relevant non-major bleeding). RESULTS Of 2,020 patients with AF, 54% (n = 1091) were females. Females with AF were older (median age 71 vs. 69, p <.001), but had less heart failure (20.9% vs. 27.2%, p = .001) and coronary artery disease (7.5% vs. 14.7%, p <.001). Females with AF were more symptomatic (74.7% vs. 66.5%, p <.001) and frequently received anticoagulant therapy (84.4% vs. 78.9%, p = .001). Rhythm control was pursued less frequently in females (23.4% vs. 27.3%, p = .04). All studied outcomes occurred with similar frequencies in females and males, and sex was not significantly predictive of any outcome. CONCLUSION Females with AF are more symptomatic, yet they are treated less with rhythm control. Despite higher risk, females have similar risk-adjusted all-cause cardiovascular death and stroke rates compared to males. Future studies should explore how treatments and interventions can influence quality-of-life and cardiovascular outcomes in females with AF.
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Affiliation(s)
- Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Al-Nusair
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Haddad
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Jadara University, Irbid, Jordan
| | - Basheer S Alghizzawi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nashmi Al-Nusair
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saleh Alhaj Mohammad
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saif M Shteiwi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Maryam K El-Zubi
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid Marie
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayham Alnsour
- Faculty of Medicine, Al-Balqa' Applied University, Salt, Jordan
| | - Mohamad Jarrah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Springer J, Pejska M, Homenda W, Zdrojewski T, Daniłowicz-Szymanowicz L, Kozłowski D. Effectiveness of antazoline versus amiodarone, flecainide and propafenone in restoring sinus rhythm at the emergency department. Adv Med Sci 2024; 69:248-255. [PMID: 38649031 DOI: 10.1016/j.advms.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/13/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Little is known about the effectiveness of pharmacological cardioversion (PCV) with antazoline in comparison to flecainide. The aim of this study was to compare the effectiveness of antazoline in restoring sinus rhythm (SR) versus amiodarone, flecainide and propafenone in a group of emergency department (ED) patients. MATERIALS/METHODS This was a single-centre retrospective analysis of patient records from an ED in a large hospital in Poland. We analysed a total of 1878 patient records, divided based on the anti-arrhythmic drug (AAD) administered during PCV: antazoline (n = 1080), antazoline + β-blocker (n = 479), amiodarone (n = 129), flecainide (n = 102), propafenone (n = 88). Of the patients, 63.5 % were female (median 65 years, [19-100]). RESULTS The percentage of successful PCV was significantly higher in the antazoline group (84.3 %) than in the antazoline + β-blocker (75.8 %, p = 0.0001), propafenone (75.6 %, p = 0.0364) and amiodarone (68.8 %, p < 0.0001) groups. Post-hoc analysis revealed that patients who received PCV with antazoline, antazoline + β-blocker, flecainide and propafenone had significantly shorter time to SR than those who received amiodarone (p < 0.0001). Univariate regression analysis revealed that patients who underwent PCV with antazoline were almost twice as likely to return to SR compared to the other groups (p < 0.0001, OR 1.81, 95 % CI 1.44-2.27). CONCLUSIONS This is the first study comparing the effectiveness of antazoline in PCV versus flecainide in addition to the previously studied amiodarone and propafenone. Our results indicate that antazoline is more effective in restoring SR than amiodarone, flecainide and propafenone. In addition, antazoline restored SR significantly faster than amiodarone or propafenone.
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Affiliation(s)
- Janusz Springer
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland.
| | - Michalina Pejska
- Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland
| | - Wojciech Homenda
- Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland
| | - Tomasz Zdrojewski
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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3
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Shantsila E, Choi EK, Lane DA, Joung B, Lip GY. Atrial fibrillation: comorbidities, lifestyle, and patient factors. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100784. [PMID: 38362547 PMCID: PMC10866737 DOI: 10.1016/j.lanepe.2023.100784] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Modern anticoagulation therapy has dramatically reduced the risk of stroke and systemic thromboembolism in people with atrial fibrillation (AF). However, AF still impairs quality of life, increases the risk of stroke and heart failure, and is linked to cognitive impairment. There is also a recognition of the residual risk of thromboembolic complications despite anticoagulation. Hence, AF management is evolving towards a more comprehensive understanding of risk factors predisposing to the development of this arrhythmia, its' complications and interventions to mitigate the risk. This review summarises the recent advances in understanding of risk factors for incident AF and managing these risk factors. It includes a discussion of lifestyle, somatic, psychological, and socioeconomic risk factors. The available data call for a practice shift towards a more individualised approach considering an increasingly broader range of health and patient factors contributing to AF-related health burden. The review highlights the needs of people living with co-morbidities (especially with multimorbidity), polypharmacy and the role of the changing population demographics affecting the European region and globally.
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Affiliation(s)
- Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Brownlow Group GP Practice, Liverpool, United Kingdom
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
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4
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Sandhu RK, Qureshi H, Halperin H, Dover DC, Klassen N, Hawkins NM, Andrade JG, Kaul P. Sex Differences in High-Cost Users of Healthcare for Atrial Fibrillation. CJC Open 2024; 6:407-416. [PMID: 38487054 PMCID: PMC10935695 DOI: 10.1016/j.cjco.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/29/2023] [Indexed: 03/17/2024] Open
Abstract
Background Healthcare resource use for atrial fibrillation (AF) is high, but it may not be equivalent across all patients. We examined whether sex differences exist for AF high-cost users (HCUs), who account for the top 10% of total acute care costs. Methods All patients aged ≥ 20 years who presented to the emergency department (ED) or were hospitalized with AF were identified in Alberta, Canada, between 2011 and 2015. The cohort was categorized by sex into HCUs and non-HCUs. Healthcare utilization was defined as ED, hospital, and physician visits, and costs included those for hospitalization, ambulatory care, physician billing, and drugs. All costs were inflated to 2022 Canadian dollars (CAD$). Results Among 48,030 AF patients, 45.1% were female. Of these, 31.8% were HCUs, and the proportions of female and male patients were equal (31.9% vs 31.7%). Female HCUs were older, more likely to have hypertension and heart failure, and had a higher stroke risk than male HCUs. Mean healthcare utilization did not differ among HCUs by sex, except for number of ED visits, which was higher in male patients (12.7% vs 9.2%, P < 0.0001). Overall, HCUs accounted for 65.8% of the total costs (CAD$3.4 billion). Almost half of total HCU costs were attributable to female HCUs (CAD$966.1 million). Significant differences were present in the distributions of HCU-related costs (male patients: 74.6% hospitalization, 9.5% ambulatory care, 12.4% physician billing, 3.5% drugs; female patients: 77.7% hospitalization, 7.4% ambulatory care, 11.5% physician billing, 3.5% drugs, P < 0.0001). Conclusions Despite having a lower AF prevalence, female patients represent an equal proportion of HCUs, and account for almost half the total HCU costs. Interventions targeted at reducing the number of AF HCU are needed, particularly for female patients.
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Affiliation(s)
- Roopinder K. Sandhu
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hena Qureshi
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Halperin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas C. Dover
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan Klassen
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nathaniel M. Hawkins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jason G. Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Padma Kaul
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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5
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Lin J, Wu XY, Long DY, Jiang CX, Sang CH, Tang RB, Li SN, Wang W, Guo XY, Ning M, Sun ZQ, Yang N, Hao YC, Liu J, Liu J, Du X, Fonarow GC, Smith SC, Lip GYH, Zhao D, Dong JZ, Ma CS. Asymptomatic atrial fibrillation among hospitalized patients: clinical correlates and in-hospital outcomes in Improving Care for Cardiovascular Disease in China-Atrial Fibrillation. Europace 2023; 25:euad272. [PMID: 37712716 PMCID: PMC10551228 DOI: 10.1093/europace/euad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS The clinical correlates and outcomes of asymptomatic atrial fibrillation (AF) in hospitalized patients are largely unknown. We aimed to investigate the clinical correlates and in-hospital outcomes of asymptomatic AF in hospitalized Chinese patients. METHODS AND RESULTS We conducted a cross-sectional registry study of inpatients with AF enrolled in the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation Project between February 2015 and December 2019. We investigated the clinical characteristics of asymptomatic AF and the association between the clinical correlates and the in-hospital outcomes of asymptomatic AF. Asymptomatic and symptomatic AF were defined according to the European Heart Rhythm Association score. Asymptomatic patients were more commonly males (56.3%) and had more comorbidities such as hypertension (57.4%), diabetes mellitus (18.6%), peripheral artery disease (PAD; 2.3%), coronary artery disease (55.5%), previous history of stroke/transient ischaemic attack (TIA; 17.9%), and myocardial infarction (MI; 5.4%); however, they had less prevalent heart failure (9.6%) or left ventricular ejection fractions ≤40% (7.3%). Asymptomatic patients were more often hospitalized with a non-AF diagnosis as the main diagnosis and were more commonly first diagnosed with AF (23.9%) and long-standing persistent/permanent AF (17.0%). The independent determinants of asymptomatic presentation were male sex, long-standing persistent AF/permanent AF, previous history of stroke/TIA, MI, PAD, and previous treatment with anti-platelet drugs. The incidence of in-hospital clinical events such as all-cause death, ischaemic stroke/TIA, and acute coronary syndrome (ACS) was higher in asymptomatic patients than in symptomatic patients, and asymptomatic clinical status was an independent risk factor for in-hospital all-cause death, ischaemic stroke/TIA, and ACS. CONCLUSION Asymptomatic AF is common among hospitalized patients with AF. Asymptomatic clinical status is associated with male sex, comorbidities, and a higher risk of in-hospital outcomes. The adoption of effective management strategies for patients with AF should not be solely based on clinical symptoms.
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Affiliation(s)
- Jing Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xue-Ying Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Zhao-Qing Sun
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Chen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
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6
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Shantsila E, Shantsila A, Lip GYH. Beyond Individual Risk Factors in Atrial Fibrillation: The Interactions of Hypertension and Sex. Am J Hypertens 2023; 36:529-531. [PMID: 37523744 DOI: 10.1093/ajh/hpad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Eduard Shantsila
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Alena Shantsila
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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7
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Kanazawa S, Kaneko H, Yano Y, Suzuki Y, Okada A, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Sex Differences in the Association Between Hypertension and Incident Atrial Fibrillation. J Am Heart Assoc 2023; 12:e026240. [PMID: 36802850 PMCID: PMC10111461 DOI: 10.1161/jaha.122.026240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Limited evidence is available on sex differences about the association between hypertension and incident atrial fibrillation (AF). Methods and Results We used a nationwide health checkup and claims database to analyze 3 383 738 adults (median age, 43 (36-51) years, 57.4% men). We investigated the relationship between hypertension and incident AF in men and women using a Cox regression model. We used restricted cubic spline functions to identify the association of blood pressure (BP) as a continuous parameter with incident AF. We categorized the men and women into 4 groups according to the 2017 American College of Cardiology/American Heart Association BP guidelines. During a mean follow-up of 1199±950 days, 13 263 AF diagnoses were recorded. The incidence (95% CI) of AF was 15.8 (15.5-16.1) per 10 000 person-years in men and 6.1 (5.9-6.3) per 10 000 person-years in women. Compared with normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were associated with an increased risk AF in both men and women. However, the hazard ratios were greater in women than in men, and the P value for interactions in the multivariable model was 0.0076. The models using restricted cubic spline showed that the risk of AF associated with elevated systolic BP increased steeply above an approximate threshold of systolic BP of 130 mm Hg in men and 100 mm Hg in women. Although our primary findings were consistent across subgroup analyses, this association was most significant in younger individuals. Conclusions Although the incidence of AF was higher in men, the association between hypertension and incident AF was more pronounced in women than in men, suggesting a potential sex difference in the relationship between hypertension and incident AF.
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Affiliation(s)
- Satoshi Kanazawa
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.,The Department of Advanced Cardiology The University of Tokyo Tokyo Japan
| | - Yuichiro Yano
- Department of Advanced Epidemiology, NCD Epidemiology Research Center Shiga University of Medical Science Shiga Japan.,The Department of Family Medicine and Community Health Duke University Durham NC
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.,Center for Outcomes Research and Economic Evaluation for Health National Institute of Public Health Saitama Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.,The Department of Advanced Cardiology The University of Tokyo Tokyo Japan
| | - Nobuaki Michihata
- The Department of Health Services Research The University of Tokyo Tokyo Japan
| | - Taisuke Jo
- The Department of Health Services Research The University of Tokyo Tokyo Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Koichi Node
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
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8
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Guo Y, Corica B, Romiti GF, Proietti M, Zhang H, Lip GYH. Efficacy of mobile health-technology integrated care based on the 'Atrial fibrillation Better Care' (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial. Intern Emerg Med 2023; 18:449-456. [PMID: 36630000 PMCID: PMC10017580 DOI: 10.1007/s11739-022-03188-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/24/2022] [Indexed: 01/12/2023]
Abstract
The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster-randomized trial showed that a mobile health (mHealth)-implemented 'Atrial fibrillation Better Care' (ABC) pathway approach reduced the risk of adverse events in atrial fibrillation (AF) patients. Whether this benefit can be applied to both males and females is unclear, especially given the suboptimal management and poorer cardiovascular outcomes in females with AF. In this post-hoc analysis, we performed a sex-stratified analysis of the mAFA-II trial. Between June 2018 and August 2019, adult AF patients were enrolled across 40 centers in China. The primary outcome was the composite of stroke, thromboembolism, all-cause death, and re-hospitalization. The effect of mAFA intervention according to sex was evaluated through adjusted Cox-regression models. Among the 3,324 patients enrolled in the trial, 2,062 (62.0%) patients were males (mean age: 67.5 ± 14.3 years; 1,021 allocated to mAFA intervention) and 1,262 (38.0%) were females (mean age: 70.2 ± 13.0; 625 allocated to mAFA intervention). A significant risk reduction of the primary composite outcome in patients allocated to mAFA intervention was observed in both males (adjusted hazard ratio [aHR] and 95% confidence interval [CI] 0.30 [0.17-0.52]) and females (aHR [95%CI] 0.50 [0.27-0.92]), without statistically significant interaction (p = 0.225). Sex-based interactions were observed for other secondary outcomes, including all-cause death (p = 0.026) and bleeding events (p = 0.032). A mHealth-technology implemented ABC pathway was similarly effective in reducing the risk of adverse clinical events both in male and female patients. Secondary outcomes showed greater benefits of mAFA intervention in men.
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Affiliation(s)
- Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Hui Zhang
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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9
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Hamade H, Jabri A, Mishra P, Butt MU, Sallam S, Karim S. Gender, ethnic, and socioeconomic differences in access to catheter ablation therapy in patients with atrial fibrillation. Front Cardiovasc Med 2023; 9:966383. [PMID: 36684570 PMCID: PMC9846247 DOI: 10.3389/fcvm.2022.966383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Female patients, patients from racial minorities, and patient with low socioeconomic status have been noted to have less access to catheter ablation for atrial fibrillation. Methods This is a cross-sectional, retrospective study using a large population database (Explorys) to evaluate the gender, racial and socioeconomic differences in access of catheter ablation therapy in patient with atrial fibrillation. Results A total of 2.2 million patients were identified as having atrial fibrillation and 62,760 underwent ablation. Females had ablation in 2.1% of cases while males received ablation in 3.4% of cases. Caucasians had ablation in 3.3% of cases, African Americans in 1.5% of cases and other minorities in 1.2% of cases. Individuals on medicaid underwent ablation in 1.6% of cases, individuals on medicare and private insurance had higher rates (2.8 and 2.9%, respectively). Logistic regression showed that female patients (OR 0.608, CI 0.597-0.618, p < 0.0001), patients who are African American (OR 0.483, CI 0.465-0.502, p < 0.0001), or from other racial minorities (OR 0.343, CI 0.332-0.355, p < 0.0001) were less likely to undergo ablation. Patient with medicare (OR 1.444, CI 1.37-1.522, p < 0.0001) and private insurance (OR 1.572, CI 1.491-1.658, p < 0.0001) were more likely to undergo ablation. Conclusion Female gender, racial minorities, low socioeconomic status are all associated with lower rates of catheter ablation in management of atrial fibrillation.
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Affiliation(s)
- Hani Hamade
- Department of Internal Medicine, The Metrohealth System, Cleveland, OH, United States
| | - Ahmad Jabri
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States
| | - Pooja Mishra
- Advocate Heart Institute, Advocate Healthcare, Chicago, IL, United States
| | - Muhammad Umer Butt
- Department of Cardiology, New York University Langone Health, New York, NY, United States
| | - Sherin Sallam
- Department of Internal Medicine, University Hospitals, Cleveland, OH, United States
| | - Saima Karim
- Heart and Vascular Center, The Metrohealth System, Cleveland, OH, United States,*Correspondence: Saima Karim ✉
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10
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Atrial Fibrillation in Women: from Epidemiology to Treatment. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Budde H, Hassoun R, Mügge A, Kovács Á, Hamdani N. Current Understanding of Molecular Pathophysiology of Heart Failure With Preserved Ejection Fraction. Front Physiol 2022; 13:928232. [PMID: 35874547 PMCID: PMC9301384 DOI: 10.3389/fphys.2022.928232] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022] Open
Abstract
Heart Failure (HF) is the most common cause of hospitalization in the Western societies. HF is a heterogeneous and complex syndrome that may result from any dysfunction of systolic or diastolic capacity. Abnormal diastolic left ventricular function with impaired relaxation and increased diastolic stiffness is characteristic of heart failure with preserved ejection fraction (HFpEF). HFpEF accounts for more than 50% of all cases of HF. The prevalence increases with age: from around 1% for those aged <55 years to >10% in those aged 70 years or over. Nearly 50% of HF patients have HFrEF and the other 50% have HFpEF/HFmrEF, mainly based on studies in hospitalized patients. The ESC Long-Term Registry, in the outpatient setting, reports that 60% have HFrEF, 24% have HFmrEF, and 16% have HFpEF. To some extent, more than 50% of HF patients are female. HFpEF is closely associated with co-morbidities, age, and gender. Epidemiological evidence suggests that HFpEF is highly represented in older obese women and proposed as ‘obese female HFpEF phenotype’. While HFrEF phenotype is more a male phenotype. In addition, metabolic abnormalities and hemodynamic perturbations in obese HFpEF patients appear to have a greater impact in women then in men (Sorimachi et al., European J of Heart Fail, 2022, 22). To date, numerous clinical trials of HFpEF treatments have produced disappointing results. This outcome suggests that a “one size fits all” approach to HFpEF may be inappropriate and supports the use of tailored, personalized therapeutic strategies with specific treatments for distinct HFpEF phenotypes. The most important mediators of diastolic stiffness are the cardiomyocytes, endothelial cells, and extracellular matrix (ECM). The complex physiological signal transduction networks that respond to the dual challenges of inflammatory and oxidative stress are major factors that promote the development of HFpEF pathologies. These signalling networks contribute to the development of the diseases. Inhibition and/or attenuation of these signalling networks also delays the onset of disease. In this review, we discuss the molecular mechanisms associated with the physiological responses to inflammation and oxidative stress and emphasize the nature of the contribution of most important cells to the development of HFpEF via increased inflammation and oxidative stress.
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Affiliation(s)
- Heidi Budde
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Roua Hassoun
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Árpád Kovács
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- *Correspondence: Nazha Hamdani,
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12
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Zhu J, Zhuo K, Zhang B, Xie Z, Li W. Sex Differences in Epicardial Adipose Tissue: Association With Atrial Fibrillation Ablation Outcomes. Front Cardiovasc Med 2022; 9:905351. [PMID: 35770221 PMCID: PMC9234200 DOI: 10.3389/fcvm.2022.905351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background There are significant differences in the prevalence and prognosis of atrial fibrillation (AF) between sexes. Epicardial adipose tissue (EAT) has been found as a risk factor for AF. This study aimed to evaluate whether sex-based EAT differences were correlated with AF recurrence and major adverse cardiovascular events (MACE). Methods In this study, postmenopausal women and age, BMI, and type of AF matched men who had received first catheter ablation were included. EAT volume was quantified based on the pre-ablation cardiac computed tomography (CT) images. Clinical, CT, and echocardiographic variables were compared by sex groups. The predictors of AF recurrence and MACE were determined through Cox proportional hazards regression. Results Women were found with significantly lower total EAT volumes (P < 0.001) but higher periatrial/total (P/T) EAT ratios (P = 0.009). The median follow-up duration was 444.5 days. As revealed by the result of the Kaplan-Meier survival analysis, the women were found to have a significantly higher prevalence of AF recurrence (log rank, P = 0.011) but comparable MACE (log rank, P = 0.507) than men. Multivariate analysis demonstrated that female gender (HR: 1.88 [95% CI: 1.03, 4.15], P = 0.032), persistent AF (HR: 2.46 [95% CI: 1.19, 5.05], P = 0.015), left atrial (LA) dimension (HR: 1.47 [95% CI: 1.02, 2.13], P = 0.041), and P/T EAT ratio (HR: 1.73 [95% CI: 1.12, 2.67], P = 0.013) were found as the independent predictors of AF recurrence. Sex-based subgroup multivariable analysis showed that the P/T EAT ratio was an independent predictor of AF recurrence in both men (HR: 1.13 [95% CI: 1.01, 1.46], P = 0.047) and women (HR: 1.37 [95% CI: 1.11, 1.67], P = 0.028). While age (HR: 1.81 [95% CI: 1.18, 2.77], P = 0.007), BMI (HR: 1.44 [95% CI: 1.02, 2.03], P = 0.038), and periatrial EAT volume (HR: 1.31 [95% CI: 1.01, 1.91], P = 0.046) were found to be independent of MACE. Conclusion Women had a higher P/T EAT ratio and AF post-ablation recurrence but similar MACE as compared with men. Female gender and P/T EAT ratio were found to be independent predictors of AF recurrence, whereas age and periatrial EAT volume were found to be independent predictors of MACE.
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Affiliation(s)
- Jing Zhu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- *Correspondence: Jing Zhu
| | - Kaimin Zhuo
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Bo Zhang
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zhen Xie
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Wenjia Li
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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13
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Islam S, Dover DC, Daniele P, Hawkins NM, Humphries KH, Kaul P, Sandhu RK. Sex Differences in the Management of Oral Anticoagulation and Outcomes for Emergency Department Presentation of Incident Atrial Fibrillation. Ann Emerg Med 2022; 80:97-107. [DOI: 10.1016/j.annemergmed.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
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14
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Albertsen N, Riahi S, Pedersen ML, Skovgaard N, Andersen S. The prevalence of atrial fibrillation in Greenland: a register-based cross-sectional study based on disease classifications and prescriptions of oral anticoagulants. Int J Circumpolar Health 2022; 81:2030522. [PMID: 35086441 PMCID: PMC8803055 DOI: 10.1080/22423982.2022.2030522] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Previous studies of the prevalence of atrial fibrillation (AF) in Greenland are based on either single-point electrocardiograms (ECGs) or patients admitted with stroke. This study estimates the prevalence of AF based on disease classifications in the electronic medical record system (EMR) and prescriptions of oral anticoagulants (OACs). Patients given a diagnose classification code for AF or atrial flutter or prescribed the vitamin K antagonist Warfarin or the direct-acting oral anticoagulant Rivaroxaban were identified in the EMR. Descriptive data and selected laboratory values were extracted, and a minimum CHA2DS2-VASc score was calculated for the 790 patients identified in the EMR (66% men). A total prevalence of AF of 1.4% was found in the general population (1.8% among men and 1.0% among women), with a significantly lower prevalence among women younger than 70 years. There was a significant increase in AF-prevalence with advancing age (p<0.001) for both men and women. A minimum CHA2DS2-VASc was estimated and app. 10% of the patients may be undertreated with OACs. The prevalence of AF found in this study is higher than that found in previous studies in Greenland and comparable to the prevalence found in other Western countries, indicating that AF is common in Greenland.
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Affiliation(s)
- N Albertsen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark.,Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - S Riahi
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - M L Pedersen
- Steno Diabetes Centre, Nuuk, Greenland.,Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
| | - N Skovgaard
- Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
| | - S Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark.,Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
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15
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Tanaka N, Inoue K, Kobori A, Kaitani K, Morimoto T, Kurotobi T, Morishima I, Yamaji H, Matsui Y, Nakazawa Y, Kusano K, Okada M, Tanaka K, Hirao Y, Oka T, Koyama Y, Okamura A, Iwakura K, Fujii K, Kimura T, Shizuta S. Sex differences in atrial fibrillation ablation outcomes: insights from a large-scale multicentre registry. Europace 2021; 22:1345-1357. [PMID: 32548641 DOI: 10.1093/europace/euaa104] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
AIM The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We investigated the sex differences regarding the efficacy and clinical outcomes of RFCA of AF. METHODS AND RESULTS We conducted a large-scale, prospective, multicentre, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centres (64 ± 10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Female patients (n = 1369, 27.3%) were older (female vs. male, 68 ± 9 vs. 63 ± 11 years, P < 0.0001) with a lower prevalence of non-paroxysmal AF (27.1% vs. 38.9%, P < 0.0001). Fewer females experienced time-dependent pulmonary vein (PV) reconnections and more females received a non-PV foci ablation than males in the index RFCA. The 3-year cumulative incidence of AF recurrences in the multivariate analysis after single procedures was significantly higher in females than males (43.3% vs. 39.0%, log rank P = 0.0046). Females remained an independent predictor of AF recurrence (hazard ratio 1.24; 95% confidence interval 1.12-1.38, P < 0.0001). The AF recurrence rates after multiple procedures were also higher in females, but fewer females experienced PV reconnections during second sessions. More females experienced de novo pacemaker implantations during the long-term follow-up. Females were associated with a higher risk of heart failure hospitalizations and major bleeding after RFCA in the multivariate analysis. CONCLUSIONS Females experienced more frequent AF recurrences probably due to non-PV arrhythmogenicity and de novo pacemaker implantations than males during the long-term follow-up after RFCA of AF.
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Affiliation(s)
- Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Otsu Red Cross Hospital, Otsu 520-0046, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Nanba Kurotobi Heart Clinic, Osaka 542-0076, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki 503-8502, Japan
| | - Hirosuke Yamaji
- Heart Rhythm Center, Okayama Heart Clinic, Okayama 703-8251, Japan
| | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital, Osaka 551-0032, Japan
| | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Heart Rhythm Center, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Yuko Hirao
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Takafumi Oka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Katsuomi Iwakura
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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16
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Volgman AS, Benjamin EJ, Curtis AB, Fang MC, Lindley KJ, Naccarelli GV, Pepine CJ, Quesada O, Vaseghi M, Waldo AL, Wenger NK, Russo AM. Women and atrial fibrillation. J Cardiovasc Electrophysiol 2020; 32:2793-2807. [PMID: 33332669 DOI: 10.1111/jce.14838] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.
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Affiliation(s)
| | - Emelia J Benjamin
- Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, California, USA
| | | | | | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Odayme Quesada
- The Christ Hospital Women's Heart Center, Cincinnati, Ohio, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Albert L Waldo
- Division of Cardiovascular Medicine, Case Western Reserve University Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nanette K Wenger
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
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17
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Ladwig KH, Goette A, Atasoy S, Johar H. Psychological aspects of atrial fibrillation: A systematic narrative review : Impact on incidence, cognition, prognosis, and symptom perception. Curr Cardiol Rep 2020; 22:137. [PMID: 32910300 PMCID: PMC7496063 DOI: 10.1007/s11886-020-01396-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF THE REVIEW Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. RECENT FINDINGS Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.
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Affiliation(s)
- Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Medizinischen Klinik II, Paderborn, Germany
- Working Group on Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
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18
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Yao RJR, Macle L, Deyell MW, Tang L, Hawkins NM, Sedlak T, Nault I, Verma A, Khairy P, Andrade JG. Impact of Female Sex on Clinical Presentation and Ablation Outcomes in the CIRCA-DOSE Study. JACC Clin Electrophysiol 2020; 6:945-954. [PMID: 32819529 DOI: 10.1016/j.jacep.2020.04.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to evaluate sex-specific differences in atrial fibrillation (AF) presentation and catheter ablation outcomes in the prospective, multicenter, randomized CIRCA-DOSE (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration) study. BACKGROUND Similar to other cardiovascular conditions, significant sex-specific differences have been observed in the epidemiology, pathophysiology, presentation, and natural history of AF. Unfortunately, there are major gaps in our understanding of the pathophysiological basis for the observed sex-specific differences and their implications on therapy and prognosis. METHODS This study examined sex-specific differences in AF presentation, symptom severity and health-related quality of life, symptomatic and asymptomatic arrhythmia recurrence, AF burden, and health care utilization. RESULTS Freedom from any atrial tachyarrhythmia and symptomatic atrial tachyarrhythmia were similar between male (hazard ratio: 1.18; 95% confidence interval: 0.85 to 1.64; p = 0.39) and female patients (hazard ratio: 1.00; 95% confidence interval: 0.62 to 1.59; p = 0.92). Post-ablation, the median AF burden (percentage time in AF) was 0.00% (interquartile range: 0.00% to 0.16%) in male patients and 0.00% (interquartile range: 0.00% to 0.17%) in female patients, with no difference observed between the sexes (p = 0.30). Periprocedural complications occurred twice as frequently in female patients (3.5% vs. 7.0%; p = 0.18). In comparison to male patients, female patients reported a significantly worse symptom score and quality of life at baseline and all follow-up intervals, but they derived similar magnitude of improvement post-ablation. There was no difference between male and female patients with respect to emergency department visits, hospitalization, cardioversion, or repeat ablation. CONCLUSIONS When compared with male patients, female patients have significantly worse symptom scores and quality of life at baseline. Despite this, female patients with symptomatic paroxysmal AF derive similar benefit in freedom from recurrent arrhythmia and similar improvements in quality of life following AF ablation. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration [CIRCA-DOSE]; NCT01913522).
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Affiliation(s)
- Ren Jie Robert Yao
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Tang
- Data Science Institute, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Paul Khairy
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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19
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Fan SM, Fann A, Nah G, Pletcher MJ, Olgin JE, Marcus GM. Characteristics of Atrial Fibrillation Patients with a Family History of Atrial Fibrillation. J Atr Fibrillation 2019; 12:2198. [PMID: 31687072 DOI: 10.4022/jafib.2198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/14/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022]
Abstract
Background Family history has been shown to be associated with increased risk of atrial fibrillation (AF). However, the specific AF characteristics that travel with a family history have not yet been elucidated. The purpose of this study was to determine whether a family history of AF is associated with specific patient characteristics in a worldwide, remote cohort. Methods From the Health eHeart Study, an internet-based prospective cohort, we performed a cross-sectional analysis of AF participants who reported their family history and completed questionnaires regarding their medical conditions and AF symptoms. We assessed demographics, cardiovascular comorbidities, and AF symptom characteristics in AF participants with and without a family history of AF. Results In multivariable analysis of 5,884 participants with AF (mean age 59.9 ± 14.5, 59% male, 92% white), female sex (odds ratio [OR]=1.35, 95% CI, 1.17-1.54, p<0.0001) and birth in the U.S. (OR=2.54, 95% CI, 2.12-3.05, p<0.0001) were independently associated with having a family history of AF. Having a family history of AF was also more commonly associated with symptoms of shortness of breath (OR=1.40, 95% CI, 1.07-1.82, p=0.014), chest pain, pressure, or discomfort (OR=1.95, 95% CI, 1.22-3.13, p=0.0052), and feeling generally "off" about oneself (OR=1.84, 95% CI, 1.27-2.67, p=0.0013). Conclusions Patients with a family history of AF are more likely to be female, be US-born, and experience symptoms of AF, suggesting underlying mechanistic differences between those with and without family history of AF.
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Affiliation(s)
- Shannon M Fan
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Amy Fann
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Gregory Nah
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California
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Groh CA, Faulkner M, Getabecha S, Taffe V, Nah G, Sigona K, McCall D, Hills MT, Sciarappa K, Pletcher MJ, Olgin JE, Marcus GM. Patient-reported triggers of paroxysmal atrial fibrillation. Heart Rhythm 2019; 16:996-1002. [DOI: 10.1016/j.hrthm.2019.01.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Indexed: 11/29/2022]
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21
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Odening KE, Deiß S, Dilling-Boer D, Didenko M, Eriksson U, Nedios S, Ng FS, Roca Luque I, Sanchez Borque P, Vernooy K, Wijnmaalen AP, Yorgun H. Mechanisms of sex differences in atrial fibrillation: role of hormones and differences in electrophysiology, structure, function, and remodelling. Europace 2018; 21:366-376. [DOI: 10.1093/europace/euy215] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/03/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands
| | - Sebastian Deiß
- Asklepios Medical Center Altona, Department of Cardiology, Arrhythmia Unit, Hamburg, Germany
| | | | - Maxim Didenko
- Department of Surgical and Interventional Arrhythmology, Kuprianov's Cardiovascular Surgery Clinic, Military Medical Academy, St. Petersburg, Russia
| | - Urs Eriksson
- Rhythmology Division, Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich-Schlieren, Switzerland
| | - Sotirios Nedios
- Heart Center, University of Leipzig, Leipzig, Germany
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Ivo Roca Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, HX Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, GA Nijmegen, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Leiden University Medical Center, ZA Leiden, The Netherlands
| | - Hikmet Yorgun
- Department of Cardiology, Electrophysiology Unit, Hacettepe University, Ankara, Turkey
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22
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Andrade JG, Deyell MW, Lee AY, Macle L. Sex Differences in Atrial Fibrillation. Can J Cardiol 2018; 34:429-436. [DOI: 10.1016/j.cjca.2017.11.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 12/13/2022] Open
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Wändell P, Carlsson AC, Holzmann MJ, Ärnlöv J, Sundquist J, Sundquist K. Mortality in patients with atrial fibrillation and common co-morbidities - a cohort study in primary care. Ann Med 2018; 50:156-163. [PMID: 29172794 PMCID: PMC6133241 DOI: 10.1080/07853890.2017.1407036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation. METHODS The study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45-64, 65-74 and ≥75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities. RESULTS During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45-64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65-74 year old men and the 45-64 year old women. Low HRs were found for hypertension among women ≥75 years of age. CONCLUSIONS In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution. KEY MESSAGES We found congestive heart failure and cerebrovascular diseases to be consistently associated with mortality in both women and men. We found hypertension to be associated with lower mortality risk among women ≥75 years of age, although this finding must be interpreted with caution. Depression was found to be associated with increased mortality risk among men and women aged 65-74 years of age.
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Affiliation(s)
- Per Wändell
- a Department of Neurobiology, Care Science and Society, Division of Family Medicine and Primary Care , Karolinska Institutet , Huddinge , Sweden
| | - Axel C Carlsson
- a Department of Neurobiology, Care Science and Society, Division of Family Medicine and Primary Care , Karolinska Institutet , Huddinge , Sweden.,b Department of Medical Sciences, Cardiovascular Epidemiology , Uppsala University , Uppsala , Sweden
| | - Martin J Holzmann
- c Functional Area of Emergency Medicine, Karolinska University Hospital , Stockholm , Sweden.,d Department of Internal Medicine , Solna, Karolinska Institutet , Stockholm , Sweden
| | - Johan Ärnlöv
- a Department of Neurobiology, Care Science and Society, Division of Family Medicine and Primary Care , Karolinska Institutet , Huddinge , Sweden.,e School of Health and Social Studies , Dalarna University , Falun , Sweden
| | - Jan Sundquist
- f Center for Primary Health Care Research, Lund University , Malmö , Sweden.,g Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Kristina Sundquist
- f Center for Primary Health Care Research, Lund University , Malmö , Sweden.,g Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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24
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Implementation of an emergency department atrial fibrillation and flutter pathway improves rates of appropriate anticoagulation, reduces length of stay and thirty-day revisit rates for congestive heart failure. CAN J EMERG MED 2017; 20:392-400. [DOI: 10.1017/cem.2017.418] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesAn evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation.MethodsThis is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians. A standardized chart review identified demographics, comorbidities, and ED treatments. The primary outcome was the rate of new AC. Secondary outcomes were ED length of stay (LOS), referrals to AFF clinic, ED revisit rates, and 30-day rates of return visits for congestive heart failure (CHF), stroke, major bleeding, and death.ResultsED AFF patients totalling 301 (129 pre-pathway [PRE]; 172 post-pathway [POST]) were included; baseline demographics were similar between groups. The rates of AC at ED presentation were 18.6% (PRE) and 19.7% (POST). The rates of new AC on ED discharge were 48.6 % PRE (95% confidence interval [CI] 42.1%-55.1%) and 70.2% POST (62.1%-78.3%) (20.6% [p<0.01; 15.1-26.3]). Median ED LOS decreased from 262 to 218 minutes (44 minutes [p<0.03; 36.2-51.8]). Thirty-day rates of ED revisits for CHF decreased from 13.2% to 2.3% (10.9%; p<0.01; 8.1%-13.7%), and rates of other measures were similar.ConclusionsThe evidence-based pathway led to an improvement in the rate of patients with new AC upon discharge, a reduction in ED LOS, and decreased revisit rates for CHF.
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25
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Méndez-Bailón M, Muñoz-Rivas N, Jiménez-García R, Hernández-Barrera V, de Miguel-Yanes JM, Villalba NL, de Miguel Diez J, Lopez-de-Andrés A. Women with atrial fibrillation and type 2 diabetes have a higher incidence of hospitalization and undergo ablation or pacemaker implantation less frequently than men. Eur J Intern Med 2017; 42:67-73. [PMID: 28506809 DOI: 10.1016/j.ejim.2017.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/20/2017] [Accepted: 05/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND We reviewed trends from 2004 to 2013 in the incidence and outcomes for atrial fibrillation (AF) in Spanish patients with type 2 diabetes mellitus (T2DM) comparing women and men. METHODS We used national hospital discharge data including all T2DM patients discharged from the hospital after AF. Patients with AF in the primary diagnosis field were selected. Discharges were grouped by sex. Incidence was calculated overall and stratified by sex. We analyzed diagnostic and therapeutic procedures, patient comorbidities, CHA2DS2-VASc score, length of hospital stay, readmission rates and in-hospital mortality (IHM). RESULTS We identified a total of 214,457 admissions for AF. Patients with T2DM accounted for 21.1% (19,505 men and 25,954 women). Women with T2DM had a significantly higher incidence of AF compared to men over the study period (IRR 1.33;95%CI 1.31-1.35). Women were significantly older (77.24±8.69years) than men (72.62±10.28years), had higher prevalences of obesity and hypertension, and higher CHA2DS2-VASc score. Women less frequently underwent ablation (3.21% vs. 1.54%; p<0.001) and received an implanted pacemaker (14.3% vs. 8.16%; p<0.001) than men. Crude IHM was 2.81% for women and 2.48% for men (p=0.030). Sex was not associated with a higher IHM after multivariable adjustment. CONCLUSIONS Our study demonstrates an increase in hospitalization for AF in diabetic women. Women were older, had a higher comorbidity index and had CHAD2DS2-VASc score than men. Women with AF and T2DM undergo ablation or pacemaker implantation less frequently than their male counterparts. After multivariable adjustment sex did not predict mortality during admissions for AF.
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Affiliation(s)
- Manuel Méndez-Bailón
- Medicine Department, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain.
| | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | | | | | | | - Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
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26
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Rosychuk RJ, Holroyd BR, Zhang X, Rowe BH, Graham MM. Sex Differences in Outcomes After Discharge from the Emergency Department for Atrial Fibrillation/Flutter. Can J Cardiol 2017; 33:806-813. [DOI: 10.1016/j.cjca.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 12/01/2022] Open
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27
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Shehab A, Zubaid M, Bhagavathula AS, Rashed WA, Alsheikh-Ali AA, AlMahmeed W, Sulaiman K, Al-Zakwani I, AlQudaimi A, Asaad N, Amin H. Sex differences in management and outcomes of patients with atrial fibrillation in the Middle East: Gulf survey of atrial fibrillation events (Gulf SAFE). PLoS One 2017; 12:e0175405. [PMID: 28520719 PMCID: PMC5435140 DOI: 10.1371/journal.pone.0175405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/24/2017] [Indexed: 11/24/2022] Open
Abstract
Differences in the management of atrial fibrillation (AF) between men and women were investigated by using Gulf SAFE data in the Middle East. The study included 2,043 patients presenting with AF to emergency room (ER) were prospectively enrolled and followed for one-year. Women were older, have higher body mass index (BMI), comorbidities, and health complications than men. With regard to management of AF, cardioversion was recommended more often for men (16.7% vs. 9.3%), and underwent electrical cardioversion (2.2% vs. 1.1%). Women were prescribed digoxin more frequently than men (25.6% vs. 17.4%) and a significant number women received warfarin alone (31.1% vs. 8.7%). No difference between the sexes was noticed in One-year rates of stroke/transient ischemic attacks (TIA) and all-cause of mortality after one-year follow-up (3.1% men vs. 3.3% women, and 7.5% vs. 7.4%). Older age (≥ 65 years), smoking, alcohol use, CHADS2 scores ≥5 were some of the significant risk factors in men with AF. Suboptimal use of anticoagulants, higher mortality and stroke/TIA events at one year are high but similar between the sexes. ER management revealed high use of rate control strategy and high rate of hospital admission was noticed in women.
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Affiliation(s)
- Abdulla Shehab
- Department of Internal Medicine, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
- * E-mail:
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Wafa A. Rashed
- Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait University, Kuwait City, Kuwait
| | - Alawi A. Alsheikh-Ali
- Division of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Wal AlMahmeed
- Division of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University and Gulf Health Research, Muscat, Oman
| | | | - Nidal Asaad
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
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28
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Gillis AM. Atrial Fibrillation and Ventricular Arrhythmias: Sex Differences in Electrophysiology, Epidemiology, Clinical Presentation, and Clinical Outcomes. Circulation 2017; 135:593-608. [PMID: 28153995 DOI: 10.1161/circulationaha.116.025312] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sex-specific differences in the epidemiology, pathophysiology, clinical presentation, clinical treatment, and clinical outcomes of atrial fibrillation (AF), sustained ventricular arrhythmias, and sudden cardiac death are recognized. Sex hormones cause differences in cardiac electrophysiological parameters between men and women that may affect the risk for arrhythmias. The incidence and prevalence of AF is lower in women than in men. However, because women live longer and AF prevalence increases with age, the absolute number of women with AF exceeds that of men. Women with AF are more symptomatic, present with more atypical symptoms, and report worse quality of life in comparison with men. Female sex is an independent risk factor for death or stroke attributable to AF. Oral anticoagulation therapy for stroke prevention has similar efficacy for men and women, but older women treated with warfarin have a higher residual risk of stroke in comparison with men. Women with AF are less likely to receive rhythm control antiarrhythmic drug therapy, electric cardioversion, or catheter ablation in comparison with men. The incidence and prevalence of sustained ventricular arrhythmias and sudden cardiac death are lower in women than in men. Women receiving implantable cardioverter defibrillators for primary prevention of sudden cardiac death are less likely to experience sustained ventricular arrhythmias in comparison with men. In contrast, women receiving a cardiac resynchronization therapy implantable cardioverter defibrillator for the treatment of heart failure are more likely to benefit than men. Women are less likely to be referred for implantable cardioverter defibrillator therapy despite current guideline recommendations. Women are more likely to experience a significant complication related to implantable cardioverter defibrillator implantation in comparison with men. Whether sex differences in treatment decisions reflect patient preferences or treatment biases requires further study.
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Affiliation(s)
- Anne M Gillis
- From Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, Canada.
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29
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Ko D, Rahman F, Schnabel RB, Yin X, Benjamin EJ, Christophersen IE. Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 2016; 13:321-32. [PMID: 27053455 DOI: 10.1038/nrcardio.2016.45] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide. During the past century, a range of risk factors has been associated with AF, severe complications from the arrhythmia have been identified, and its prevalence has been increasing steadily. Whereas evidence has accumulated regarding sex-specific differences in coronary heart disease and stroke, the differences between women and men with AF has received less attention. We review the current literature on sex-specific differences in the epidemiology of AF, including incidence, prevalence, risk factors, and genetics, and in the pathophysiology and the clinical presentation and prognosis of patients with this arrhythmia. We highlight current knowledge gaps and areas that warrant future research, which might advance understanding of variation in the risk factors and complications of AF, and ultimately aid more-tailored management of the arrhythmia.
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Affiliation(s)
- Darae Ko
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine
| | - Faisal Rahman
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Oudenarder Strasse 16, 13347 Berlin, Germany
| | - Xiaoyan Yin
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue Framingham, Massachusetts 01702, USA.,Department of Biostatistics, Boston University School of Public Health
| | - Emelia J Benjamin
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue Framingham, Massachusetts 01702, USA.,Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, USA
| | - Ingrid E Christophersen
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts, 02129, USA.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Sogneprest Munthe-kaas vei 100, 1346 Gjettum, Norway
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