Gender and contemporary risk of adverse events in atrial fibrillation

• Published in: European heart journal Vol. 45; no. 36; pp. 3707 - 3717
• Main Authors: Champsi, Asgher, Mobley, Alastair R, Subramanian, Anuradhaa, Nirantharakumar, Krishnarajah, Wang, Xiaoxia, Shukla, David, Bunting, Karina V, Molgaard, Inge, Dwight, Jeremy, Arroyo, Ruben Casado, Crijns, Harry J G M, Guasti, Luigina, Lettino, Maddalena, Lumbers, R Thomas, Maesen, Bart, Rienstra, Michiel, Svennberg, Emma, Țica, Otilia, Traykov, Vassil, Tzeis, Stylianos, van Gelder, Isabelle, Kotecha, Dipak
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 29.09.2024
• Subjects: Administration, Oral; Adult; Aged; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Fast Track – Clinical Research; Female; Humans; Ischemic Stroke - epidemiology; Male; Middle Aged; Risk Assessment; Risk Factors; Sex Factors; Stroke - epidemiology; Stroke - etiology; Thromboembolism - epidemiology; Thromboembolism - etiology; Thromboembolism - prevention & control; United Kingdom - epidemiology; United Kingdom; Women; Stroke; Gender; Thromboembolism; Atrial fibrillation; Sex
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehae539

Abstract Background and Aims The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial. Methods The population cohort study used electronic healthcare records of 16 587 749 patients from UK primary care (2005–2020). Primary (composite of all-cause mortality, ischaemic stroke, or arterial thromboembolism) and secondary outcomes were analysed using Cox hazard ratios (HR), adjusted for age, socioeconomic status, and comorbidities. Results 78 852 patients were included with AF, aged 40–75 years, no prior stroke, and no prescription of oral anticoagulants. 28 590 (36.3%) were women, and 50 262 (63.7%) men. Median age was 65.7 years (interquartile range 58.5–70.9), with women being older and having other differences in comorbidities. During a total follow-up of 431 086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs. men (95% confidence interval [CI] 0.87–0.92; P < .001) and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83–0.91; P < .001). This was driven by lower mortality in women (HR 0.86, 95% CI 0.83–0.89; P < .001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 95% CI 0.94–1.07; P = .87), any stroke or any thromboembolism (adjusted HR 1.02, 95% CI 0.96–1.07; P = .58), and incident vascular dementia (adjusted HR 1.13, 95% CI 0.97–1.32; P = .11). Clinical risk scores were only modest predictors of outcomes, with CHA2DS2-VA (ignoring gender) superior to CHA2DS2-VASc for primary outcomes in this population (receiver operating characteristic curve area 0.651 vs. 0.639; P < .001) and no interaction with gender (P = .45). Conclusions Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation. Structured Graphical Abstract Structured Graphical Abstract The impact of gender on adverse events in patients with atrial fibrillation (AF) based on a population cohort study using electronic healthcare records from UK primary care (2005–20).