Atrial fibrillation in women: treatment

• Published in: Nature reviews cardiology Vol. 14; no. 2; pp. 113 - 124
• Main Authors: Ko, Darae, Rahman, Faisal, Martins, Maria A. P., Hylek, Elaine M., Ellinor, Patrick T., Schnabel, Renate B., Benjamin, Emelia J., Christophersen, Ingrid E.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2017; Nature Publishing Group
• Subjects: 692/4019/592/75/29/1309; 692/700/565/1436; 692/700/565/2776; Atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - psychology; Atrial Fibrillation - therapy; Cardiac Imaging; Cardiac Surgery; Cardiology; Care and treatment; Demographic aspects; Development and progression; Female; Forecasts and trends; Humans; Medical care utilization; Medical research; Medicine & Public Health; Patient Care Management - methods; Prognosis; Quality of Life; review-article; Sex Factors; Women's health
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/nrcardio.2016.171

Key Points Evaluation of sex-specific differences, disparity, and bias in health-care utilization requires presence of adverse outcomes and investigation into treatment eligibility, contraindications to treatment, patient preferences, and confounding owing to patient characteristics Women are less likely to undergo rhythm-control treatment than men; among individuals undergoing rhythm-control treatment, women are less likely to receive electrical cardioversion and catheter ablation than men No significant differences exist in the use of oral anticoagulants between women and men; however, among individuals receiving dabigatran, women are more likely to receive the lower dose than men Warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) have similar efficacy in women and men; however, among individuals receiving warfarin, women might have higher residual risk of stroke or systemic embolism Warfarin and NOACs have similar bleeding risks in women and men Future studies need to examine patient, provider, and health-system factors to address whether disparities or bias contribute to sex-specific differences in utilization and outcomes of treatments for atrial fibrillation Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. In this Review, Ko et al . summarize the evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy. Sex-specific differences in the epidemiology, pathophysiology, presentation, prognosis, and treatment of atrial fibrillation (AF) are increasingly recognized. Women with AF generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. Effective treatment of the arrhythmia in women is critical to reduce the rate of adverse events. We review the current evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy. In addition, we provide a critical evaluation of potential disparities and biases in health-care use that might be associated with differences in the outcomes between women and men. We underscore current knowledge gaps that need to be addressed in future studies to improve the management of AF in women. In particular, we suggest several strategies to produce high-quality evidence from randomized clinical trials for women with AF.