Sex differences in clinical features, utilization of oral anticoagulant agents, and 1-year outcome in Middle Eastern patients with atrial fibrillation

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.

Keywords:

• Women
• atrial fibrillation
• sex differences
• anticoagulants
• antiarrhythmics

Transparency

Declaration of funding

This study received no funding or grants.

Declaration of financial other/relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Nasr Alrabadi, Mohamad Jarrah, Karem H. Alzoubi, and Ayman Hammoudeh were involved in the conception and design. Nasr Alrabadi, Mohammed Al-Nusair, Razan Haddad, Basheer S. Alghizzawi, Nashmi Al-Nusair, Saleh Alhaj Mohammad, Saif M. Shteiwi, Maryam K. El-zubi, Zaid Marie, and Ayham Alnsour were involved in analysis and interpretation of the data. Nasr Alrabadi, Mohammed Al-Nusair, Razan Haddad, Mohamad Jarrah, Karem H. Alzoubi, and Ayman Hammoudeh were involved in the drafting of the paper. Razan Haddad, Basheer S. Alghizzawi, Nashmi Al-Nusair, Saleh Alhaj Mohammad, Saif M. Shteiwi, Maryam K. El-zubi, Zaid Marie, and Ayham Alnsour were involved in revising the manuscript critically for intellectual content. All authors approved of the version to be published.

Acknowledgements

None.

 Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.