Bridging the gender gap in atrial fibrillation

Abstract

Women have a similar lifetime prevalence of non-valvular atrial fibrillation (NVAF) compared with that of men. Given the significant morbidity and potential mortality associated with NVAF, it is crucial to understand gender differences with NVAF. Women can be more symptomatic than men. Despite a higher baseline stroke risk, they are less likely to be on anticoagulation. Women have a greater risk of thromboembolism and a similar rate of bleeding risk compared with men on anticoagulation. Initial experience suggests that novel oral anticoagulants have similar safety and efficacy profile in men and women. Although women can have more adverse reactions from antiarrhythmic therapies, they are often referred later than men for ablation. As a group, a mitigating factor in ablation referral is that women also have a higher incidence of procedural complications from catheter ablation. This review summarizes the available literature highlighting significant gender-based differences and also highlights areas for research to improve NVAF outcomes in women.

Keywords:

• atrial fibrillation
• gender
• management
• outcomes
• pathophysiology

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The lifetime prevalence of atrial fibrillation is similar in men and women.

• Non-valvular atrial fibrillation (NVAF) is associated with significant morbidity, and abolishes the survival advantage in women.

• Women with NVAF are more symptomatic with higher heart rates at presentation.

• Women with NVAF have a higher incidence of diabetes and hypertension, and a lower incidence of smoking and cardiomyopathy than men.

• Women are more prone to antiarrhythmic complications, and have higher QT intervals at baseline.

• Women are less likely to be on anticoagulation despite similar to higher thromboembolic risks.

• NOACs and warfarin offer similar benefit and safety in women.

• Women are less likely to be referred for NVAF ablation, and are referred later compared with men with NVAF.

• There is a lower rate of NVAF ablation success in women likely from late referrals, with a higher incidence of complications.