Gender Affects Outcomes in Patients with Non-Valvular Atrial Fibrillation

Women with non-valvular atrial fibrillation (NVAF) have a higher risk of stroke and systemic embolism (SE) than men with the condition, according to a recent study.

The study included 28,624 patients newly diagnosed NVAF and enrolled in GARFIELD-AF, a prospective non-interventional registry. Of the participants, 44.4% were women and 55.6% were men.
___________________________________________________________________________________________________________________________________________
RELATED CONTENT
More Women Die From AF and Flutter Than Men
Study: 1 in 8 AF Patients Receive Off-Label Dosing of NOACs
___________________________________________________________________________________________________________________________________________

Overall, the all-cause mortality rates for women and men were 4.48 and 4.04 per 100 person-years, rates for stroke/SE were 1.62 and 1.17 per 100 person-years, and rates for major bleeding were 0.93 and 0.79 per 100 person-years, respectively.

The hazard ratio for stroke/SE was 1.3-fold higher in woman compared with men after researchers adjusted for baseline risk factors in both treated and untreated patients. The ratios were similar for major bleeding and all-cause mortality.

Of the participants, 63.8% of women and 62.9% of men received anticoagulant (AC) with or without antiplatelets. All-cause mortality reduction in men and women receiving AC treatment was similar, but the reduction of stroke and SE was greater in men than in women.

In addition, the risk of major bleeding for women and men treated with AC compared to no AC treatment was 1.86 and 2.33, respectively.

“Across the models, we found that only prior stroke and AC treatment were significantly associated with gender-related differences in stroke event rates after adjustment for baseline risk factors,” the researchers wrote. “The increased benefit of AC treatment on stroke prevention in men, relative to women, is not fully understood, but suggests that women may be less well anticoagulated.”

—Melissa Weiss

Reference:

Camm AJ, Accetta G, Mahmeed WA, et al. Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry [published online March 6, 2017]. BMJ Open. doi:10.1136/bmjopen-2016-014579.