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Sex-related differences in prevalence, treatment and outcomes in patients with atrial fibrillation

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Abstract

To analyze sex-related differences about AF prevalence, use of OAC and outcomes focusing on the older age classes. We used administrative data of the Lombardy Region, describing period prevalence, use of OAC and outcomes from 2002 to 2014 for all patients diagnosed with AF. AF prevalence over the 2002–2014 period was higher in males than in females (2.7% vs. 2.1%, p < 0.001), increasing with age. From 2003 to 2014, not treated AF patients decreased mostly in males (from 40.3 to 33.7% with respect to 43.7–39.8% in females). Age-stratified adjusted logistic regression analysis found that females were more likely treated with OAC when < 65 years in 2003 (OR 1.51, 95% CI 1.35–1.69) and in 2014 (OR 1.32, 95% CI 1.13–1.53); contrariwise, were less likely treated with OAC when age ≥ 75 years, in 2003 (OR 0.92, 95% CI 0.86–0.98) and in 2014 (OR 0.77, 95% CI 0.72–0.81).Adjusted Cox regression analysis confirmed that female AF patients had a higher risk of stroke (HR 1.18, 95% CI 1.14–1.21) and a lower risk of major bleeding (HR 0.83, 95% CI 0.80–0.86), while, had a lower risk for all-cause death (HR 0.82, 95% CI 0.80–0.83). AF prevalence was higher in male than in female patients, while thromboembolic risk was higher in female. Older female patients were under-treated with OAC particularly in recent years. Over long-term follow-up, female had a higher risk of stroke and a lower risk of major bleeding and all-cause death.

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Acknowledgements

We thank Igor Monti from IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Simone Schiatti and Giovanna Rigotti from Lombardia Informatica S.p.A, Alfredo Bevilacqua from SANTER Reply S.p.A. We are grateful to Fiorenza Clerici for secretarial assistance.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Laboratory of Cardiovascular Prevention, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy

    Irene Marzona, Tommaso Vannini & Maria Carla Roncaglioni

  2. Department of Neuroscience, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy

    Marco Proietti, Mauro Tettamanti & Alessandro Nobili

  3. Regional Health Ministry, Lombardy Region, Milan, Italy

    Massimo Medaglia, Angela Bortolotti & Luca Merlino

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  1. Irene Marzona
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  9. Maria Carla Roncaglioni
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Contributions

Study concept and design: Irene Marzona, Marco Proietti, Mauro Tettamanti, and Maria Carla Roncaglioni. Acquisition of data: Massimo Medaglia, Angela Bortolotti, and Luca Merlino. Analysis of data: Tommaso Vannini and Mauro Tettamanti. Interpretation of data: Irene Marzona, Marco Proietti, Maria Carla Roncaglioni, and Alessandro Nobili. Drafting of manuscript: Irene Marzona and Marco Proietti. Critical revision of the manuscript for important intellectual content: Irene Marzona, Marco Proietti, Alessandro Nobili, Mauro Tettamanti, Angela Bortolotti, Luca Merlino, and Maria Carla Roncaglioni.

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Correspondence to Irene Marzona.

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Marzona, I., Proietti, M., Vannini, T. et al. Sex-related differences in prevalence, treatment and outcomes in patients with atrial fibrillation. Intern Emerg Med 15, 231–240 (2020). https://doi.org/10.1007/s11739-019-02134-z

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