AF-related symptoms and quality of life worse in women
By Laura Cowen
Women with atrial fibrillation (AF) experience more severe symptoms, a lower quality of life (QoL) and a higher risk of stroke than men, but they have better overall survival, US study data show.
Therefore, “[c]linicians evaluating women with AF should be aware of these differences and ensure that symptom burden and QoL are carefully evaluated before selecting a treatment strategy”, say Jonathan Piccini (Duke University Medical Center, Durham, North Carolina) and co-researchers.
The observational study of 10,135 patients enrolled in the prospective Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) between June 2010 and August 2011 showed that the 4293 (42%) women, who were significantly older than the men (77 vs 73 years), generally reported more symptoms.
Specifically, palpitations (40 vs 27%) light-headedness/dizziness (23 vs 19%) and fatigue (28 vs 25%) were all significantly more common in women than men.
In addition, women had significantly greater functional impairment at baseline as reflected by higher European Heart Rhythm Association scores for mild, severe and disabling symptoms.
Indeed, only 32.1% were asymptomatic at this point, compared with 42.5% of men.
There were several important differences in baseline characteristics between men and women, including demographics, comorbidity, prior treatment, imaging results and laboratory evaluations.
After adjustment for these variables, the researchers found that women included in a health-related QoL substudy of 2007 patients had a significant 24% lower QoL, as measured with Atrial Fibrillation Effects on Quality of Life (AFEQT) scores, than men.
Piccini and team also note that although women had similar rates of anticoagulation and spent a similar time in therapeutic range to men, their risk of stroke or non-central nervous system embolism was a significant 39% higher during a median follow-up period of 2.3 years.
By contrast, all cause mortality and cardiovascular death risks were 43% and 44% lower, respectively, in women than men.
“The reasons for this stroke-survival paradox are not clear; however, the paradox highlights the need for studies focused on how treatment and interventions specifically affect cardiovascular outcomes in women and men with AF”, the authors remark.
Writing in JAMA Cardiology, Piccini and co-authors conclude: “Health status instruments, such as AFEQT, may be a valuable resource for identifying patients who might benefit from more aggressive or more specific treatment.
“More importantly, our data suggest that women are at increased risk for more severe symptom burden and lower QoL compared with men, underscoring the benefits of directly measuring patient-reported health status as a means for minimizing differences in AF management.”
JAMA Cardiol 2016; Advance online publication
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