Analyzing Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management?
Abstract Background: There are inconsistent and conflicting data among males and females with AF. Objective: This study intends to analyze whether the sex-based differences among AF patients were influenced by age, co-morbidities, and treatment strategy rather than solely gender difference. Methods: We analyzed 327 consecutive patients admitted to the ED due to AF for three years and follow-up for a year. Results: Females with AF were older (p<.001), had higher BMI (p<.001), and a higher rate of co-morbidities as hypertension (p<.001), hyperlipidemia (p=0.01), Diabetes mellitus (p=0.05), valvular heart disease (p=0.05) and thyroid dysfunction (18.3% vs. 1.8%, p<.001). AF males had a higher rate of coronary disease (p<.001) and heart disease with reduced ejection fraction (p<.001). As a result, the mean CHADS2 and CHA2DS2-VASc scores were significantly higher in females (p<.001 for both). Female tends to be treated with rate control medications and less with antiarrhythmic agents (p<.001). Univariate analysis reveals that females had a higher rate of recurrent AF, heart failure hospitalization, CVA, and myocardial infarction. Yet, adjusting gender to age and co-morbidities shows that the females remain to have a higher rate of heart failure hospitalization (OR 2.73 95%CI 1.04-5.89, P-value <.001) and recurrent AF (OR 3.86, P-value =0.02). Thyroid dysfunction and the lack of antiarrhythmic treatment significantly increase the risk of AF (OR 5.95 95%CI 3.15-9.73, OR 3.42, respectively, P-value<.001 for both) regardless of gender. The mortality rate differs only in a sub-group of females ≥ 75 years of age (OR 1.60, P<.001). Conclusion AF males and females differ significantly in baseline characteristics. Females are older, have more co-morbidities, and tend to be treated unnecessarily differently for AF. Following age and co-morbidities adjustments, a female gender remains significant for heart failure hospitalization and recurrent AF. Thyroid dysfunction and AF treatment may explain the sex-based difference of recurrent AF.