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CLINICAL RESEARCH: ATRIAL FIBRILLATION

Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe

A Report From the Euro Heart Survey on Atrial Fibrillation

Nikolaos Dagres, MD^_*,_*, Robby Nieuwlaat, MSc, Panos E. Vardas, MD, PhD, FACC, Dietrich Andresen, MD, FACC, Samuel Lévy, MD, FACC^||, Stuart Cobbe, MD^¶, Dimitrios Th. Kremastinos, MD, FACC^_*, Günter Breithardt, MD, FACC^#, Dennis V. Cokkinos, MD, FACC^_** and Harry J.G.M. Crijns, MD

^_* University of Athens, Second Cardiology Department, Attikon University Hospital, Athens, Greece
Academic Hospital Maastricht, Department of Cardiology, Maastricht, the Netherlands
University Hospital of Heraklion, Department of Cardiology, Heraklion, Greece
Vivantes Klinikum am Urban, Department of Cardiology, Berlin, Germany
^|| Hopital Nord, Department of Cardiology, Marseille, France
^¶ Royal Infirmary, Department of Medical Cardiology, Glasgow, Scotland
^# University Hospital Münster, Department of Cardiology and Angiology, Münster, Germany
^_** Onassis Cardiac Surgery Center, First Cardiology Department, Athens, Greece

Manuscript received April 7, 2006; revised manuscript received September 29, 2006, accepted October 16, 2006.

^_* Reprint requests and correspondence: Dr. Nikolaos Dagres, Second University Cardiology Department, Attikon Hospital, Rimini 1, 12462 Athens, Greece. (Email: nikolaosdagres{at}yahoo.de).

OBJECTIVES: This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe.

BACKGROUND: Gender-related differences may play a significant role in AF.

METHODS: We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation.

RESULTS: Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p < 0.001), and less often had HF with systolic dysfunction (17% vs. 26%, p < 0.001). Among patients with typical AF symptoms (56% of women, 49% of men), there was no gender-related difference in the choice of rate or rhythm control. Among patients with atypical or no symptoms (44% of women, 51% of men), women less frequently underwent rhythm control (39% vs. 51%, p < 0.001) than did men. Women underwent less electrical cardioversion (22% vs. 28%, p < 0.001). Prescription of oral anticoagulants was identical (65%) in both genders. One-year outcome was similar except that women had a higher chance for stroke (odds ratio 1.83 in multivariable regression analysis, p = 0.019).

CONCLUSIONS: Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar.

Abbreviations and Acronyms   ACC = American College of Cardiology   AF = atrial fibrillation   AHA = American Heart Association   CAD = coronary artery disease   EQ-VAS = EuroQoL Questionnaire–Visual Analogue Scale   EQ-5D = EuroQoL Questionnaire–Five-Dimension Score   ESC = European Society of Cardiology   HF = heart failure   ICD = implantable cardioverter-defibrillator   OR = odds ratio   QoL = quality of life

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