Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database
Abstract Background Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-021-02419-2 |
| _version_ | 1798026826178625536 |
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| author | Vinita Subramanya J’Neka S. Claxton Pamela L. Lutsey Richard F. MacLehose Lin Y. Chen Alanna M. Chamberlain Faye L. Norby Alvaro Alonso |
| author_facet | Vinita Subramanya J’Neka S. Claxton Pamela L. Lutsey Richard F. MacLehose Lin Y. Chen Alanna M. Chamberlain Faye L. Norby Alvaro Alonso |
| author_sort | Vinita Subramanya |
| collection | DOAJ |
| description | Abstract Background Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. Methods We studied 135,850 men and 139,767 women aged ≥ 75 years diagnosed with AF in the MarketScan Medicare database between 2007 and 2015. Anticoagulant use was defined as use of warfarin or a direct oral anticoagulant. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmic medication, catheter ablation or cardioversion. We used multivariable Poisson and Cox regression models to estimate the association of sex with treatment strategy and to determine whether the association of treatment strategy with adverse outcomes (bleeding, heart failure and stroke) differed by sex. Results At the time of AF, women were on average (SD) 83.8 (5.6) years old and men 82.5 (5.2) years, respectively. Compared to men, women were less likely to receive an anticoagulant or rhythm control treatment. Rhythm control (vs. rate) was associated with a greater risk for heart failure with a significantly stronger association in women (HR women = 1.41, 95% CI 1.34–1.49; HR men = 1.21, 95% CI 1.15–1.28, p < 0.0001 for interaction). No sex differences were observed for the association of treatment strategy with the risk of bleeding or stroke. Conclusion Sex differences exist in the treatment of AF among patients aged 75 years and older. Women are less likely to receive an anticoagulant and rhythm control treatment. Women were also at a greater risk of experiencing heart failure as compared to men, when treated with rhythm control strategies for AF. Efforts are needed to enhance use AF therapies among women. Future studies will need to delve into the mechanisms underlying these differences. |
| first_indexed | 2024-04-11T18:41:31Z |
| format | Article |
| id | doaj.art-0be4380207714c18a9bd3c4b4ce73ef8 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-04-11T18:41:31Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-0be4380207714c18a9bd3c4b4ce73ef82022-12-22T04:08:57ZengBMCBMC Cardiovascular Disorders1471-22612021-12-0121111210.1186/s12872-021-02419-2Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan databaseVinita Subramanya0J’Neka S. Claxton1Pamela L. Lutsey2Richard F. MacLehose3Lin Y. Chen4Alanna M. Chamberlain5Faye L. Norby6Alvaro Alonso7Department of Epidemiology, Rollins School of Public Health, Emory UniversityDepartment of Epidemiology, Rollins School of Public Health, Emory UniversityDivision of Epidemiology and Community Health, School of Public Health, University of MinnesotaDivision of Epidemiology and Community Health, School of Public Health, University of MinnesotaCardiovascular Division, Department of Medicine, University of Minnesota Medical SchoolDepartment of Quantitative Health Sciences, Mayo ClinicDepartment of Cardiology, Smidt Heart Institute, Cedars-Sinai Health SystemDepartment of Epidemiology, Rollins School of Public Health, Emory UniversityAbstract Background Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. Methods We studied 135,850 men and 139,767 women aged ≥ 75 years diagnosed with AF in the MarketScan Medicare database between 2007 and 2015. Anticoagulant use was defined as use of warfarin or a direct oral anticoagulant. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmic medication, catheter ablation or cardioversion. We used multivariable Poisson and Cox regression models to estimate the association of sex with treatment strategy and to determine whether the association of treatment strategy with adverse outcomes (bleeding, heart failure and stroke) differed by sex. Results At the time of AF, women were on average (SD) 83.8 (5.6) years old and men 82.5 (5.2) years, respectively. Compared to men, women were less likely to receive an anticoagulant or rhythm control treatment. Rhythm control (vs. rate) was associated with a greater risk for heart failure with a significantly stronger association in women (HR women = 1.41, 95% CI 1.34–1.49; HR men = 1.21, 95% CI 1.15–1.28, p < 0.0001 for interaction). No sex differences were observed for the association of treatment strategy with the risk of bleeding or stroke. Conclusion Sex differences exist in the treatment of AF among patients aged 75 years and older. Women are less likely to receive an anticoagulant and rhythm control treatment. Women were also at a greater risk of experiencing heart failure as compared to men, when treated with rhythm control strategies for AF. Efforts are needed to enhance use AF therapies among women. Future studies will need to delve into the mechanisms underlying these differences.https://doi.org/10.1186/s12872-021-02419-2Atrial fibrillationAnticoagulationRate controlRhythm controlSex differencesHeat failure |
| spellingShingle | Vinita Subramanya J’Neka S. Claxton Pamela L. Lutsey Richard F. MacLehose Lin Y. Chen Alanna M. Chamberlain Faye L. Norby Alvaro Alonso Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database BMC Cardiovascular Disorders Atrial fibrillation Anticoagulation Rate control Rhythm control Sex differences Heat failure |
| title | Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database |
| title_full | Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database |
| title_fullStr | Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database |
| title_full_unstemmed | Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database |
| title_short | Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database |
| title_sort | sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the marketscan database |
| topic | Atrial fibrillation Anticoagulation Rate control Rhythm control Sex differences Heat failure |
| url | https://doi.org/10.1186/s12872-021-02419-2 |
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