Women suffer more with atrial fibrillation, survive longer

May 18, 2016 – DCRI researchers evaluated 4,293 women and 5,842 men treated for atrial fibrillation at 176 practices throughout the country.

Despite having more symptoms, worse quality of life and greater risk of stroke, women with atrial fibrillation also have better overall survival than men with the same disease, researchers from the DCRI report.

This stroke-survival paradox for women with atrial fibrillation, while not fully understood, suggests key differences in how cardiovascular treatments affect outcomes in women compared to men. The findings,published May 18 in the journal JAMA Cardiology, should be taken into account when doctors guide care.

jonathan-piccini“For example, it’s important to determine whether atrial fibrillation is causing symptoms in women, because that could determine whether drugs are prescribed to control heart rhythm,” said lead author Jonathan D. Piccini, MD, an assistant professor of medicine and electrophysiology at Duke. “That’s an important distinction with clinical implications, because women are more likely to have worse quality of life and functional impairment, and this could be a consequence of drug therapies.”

The Duke researchers evaluated 4,293 women and 5,842 men who were treated for atrial fibrillation at 176 practices throughout the country, spanning a wide variety of settings from small community practices to large academic medical centers. The patients were enrolled between June 2010 and August, 2011, and were followed for a median 2.3 years.

This large group of patients in “real-world” situations gave researchers a unique insight into treatments and health status for atrial fibrillation, which is the most common form of abnormal heart rhythm. The condition afflicts more than 2 million people in the United States.

The researchers found key differences in how the condition manifests in women and men. Women experienced significantly more symptoms, including heart palpitations, light-headedness, fatigue and chest discomfort. Such symptoms, along with concerns about treatments and impaired ability to perform daily activities, contributed to a lower quality of life.

Women were also at higher risk for stroke and embolism than men, while the risks of heart failure, major bleeding and hospitalizations were similar between the sexes.

Yet despite having a more difficult disease presentation than men, women still had a lower risk for most severe outcomes, including death by any cause and cardiovascular death.

“It is a paradox that women seem to have worse disease and do better in the end,” Piccini said. “We don’t why that is – and this bears further study – but these differences between men and women are important and likely to inform us about the nature of atrial fibrillation. We need to treat both women and men in ways that take into account these differences, so that we eventually can eliminate them.”

In addition to Piccini, study authors include DaJuanicia N. Simon; Benjamin A. Steinberg; Laine Thomas; Larry A. Allen; Gregg C. Fonarow; Bernard Gersh; Elaine Hylek; Peter R. Kowey; James A. Reiffel; Gerald V. Naccarelli; Paul S. Chan; John A. Spertus; and Eric D. Peterson.