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Women with AF live longer than men, but face worse quality of life
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Despite a higher survival rate, women with atrial fibrillation experience more symptoms and have greater functional impairment and worse quality of life compared with men with AF, researchers reported.
Jonathan P. Piccini Sr., MD, MHS, FACC, FAHA, FHRS, cardiac electrophysiologist and associate professor of medicine at Duke University Medical Center, and colleagues investigated whether there were differences in symptoms, quality of life, treatment and outcomes between men and women with AF enrolled in the ORBIT-AF registry. From June 2010 to August 2011, 4,293 (42%) women and 5,842 (58%) men were enrolled at 176 U.S. sites. Median follow-up was 2.3 years.
Jonathan P. Piccini
Compared with men, the women were older (mean, 77 vs. 73 years) and had a lower frequency of obstructive sleep apnea and CAD, but had worse renal function and a higher median CHA2DS2-VASc score at baseline.
Stroke-survival paradox
Some of the key differences between women and men with AF included:
Women had greater functional impairment and reported more symptoms, most commonly palpitations, lightheadedness/dizziness and fatigue. In the overall cohort, only 32% of women were asymptomatic compared with 42.5% of men (P < .001).
Women had lower Atrial Fibrillation Effect on Quality of Life scores compared with men (mean score for women, 80; interquartile range [IQR], 62-92; mean score for men, 83; IQR, 69-94; P < .001). After adjustment, the adjusted OR for lower quality of life among women was 0.76 (95% CI, 0.68-0.84).
Although there was no observed difference in mortality between women and men with AF, after adjustment for baseline risk, women had a lower risk for most adverse events, including all-cause mortality (adjusted HR = 0.57; 95% CI, 0.49-0.67), CV death (adjusted HR = 0.56; 95% CI, 0.44-0.72) and non-CV death (adjusted HR = 0.74; 95% CI, 0.62-0.88).
Women had increased risk for stroke or noncentral nervous system embolism (adjusted HR = 1.39; 95% CI, 1.05-1.84).
“The reasons for this stroke-survival paradox may have important implications for AF-directed therapies in women and men,” the researchers wrote. “Future studies should focus on how treatment and interventions specifically affect AF-related quality of life and [CV] outcomes in women.”
Generalizability limited
In an accompanying editorial, Rod S. Passman, MD, MSCE, professor in medicine-cardiology and preventive medicine at Northwestern University Feinberg School of Medicine, called the study findings “important” and “interesting,” but emphasized that generalizability is limited because the data come from a registry.
Rod S. Passman
“Overall, patient registries can demonstrate what issues are worthy of future exploration, but the findings are usually more hypothesis-generating than definitive,” he said. “The ORBIT-AF registry shows us that ‘you can observe a lot just by watching,’ but in medicine, watching is usually just the beginning.” – by Tracey Romero
Disclosure: Passman reports consulting and receiving research/speaking fees from Medtronic; royalties for UpToDate; and consultant fees from Boehringer Ingelheim and Janssen Pharmaceuticals. Piccini reports receiving a grant from Janssen Pharmaceuticals; consultant fees from Bristol-Myers Squibb/Pfizer, Forest Laboratories, Janssen Scientific Affairs, Johnson & Johnson, Medtronic and Spectranetics; and research support from ARCA Biopharma, Boston Scientific, GE Healthcare and Johnson & Johnson/Janssen Scientific Affairs. Please see the full study for the other researchers’ relevant financial disclosures.
Perspective
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Sumeet S. Chugh, MD
As reported for many other medical conditions, women and men may differ significantly in how they react to AF and how they respond to treatment. Whatever the focus, future research on AF should require sex-specific design and analysis.
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