Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management?
Asaf Israeli,1 Danna Gal,1 Autba Younis,2 Scott Ehrenberg,1 Ehud Rozner,3 Yoav Turgeman,1,3 Edmund Naami,4 Robert Naami,5 Ofir Koren1,3 1Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; 2Internal Medicine E, Emek Medical Center, Afula, Israel; 3Heart Insti...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2022-05-01
|
| Series: | Vascular Health and Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/sex-differences-in-atrial-fibrillation-patients-bias-or-proper-managem-peer-reviewed-fulltext-article-VHRM |
| _version_ | 1828796028457844736 |
|---|---|
| author | Israeli A Gal D Younis A Ehrenberg S Rozner E Turgeman Y Naami E Naami R Koren O |
| author_facet | Israeli A Gal D Younis A Ehrenberg S Rozner E Turgeman Y Naami E Naami R Koren O |
| author_sort | Israeli A |
| collection | DOAJ |
| description | Asaf Israeli,1 Danna Gal,1 Autba Younis,2 Scott Ehrenberg,1 Ehud Rozner,3 Yoav Turgeman,1,3 Edmund Naami,4 Robert Naami,5 Ofir Koren1,3 1Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; 2Internal Medicine E, Emek Medical Center, Afula, Israel; 3Heart Institute, Emek Medical Center, Afula, Israel; 4Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA; 5Department of Medicine, University Hospitals Cleveland Medical center, Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Ofir Koren, Heart Institute, Emek Medical Center, 21 Rabin Boulevard, Afula, 1834111, Israel, Tel +972-04-6495585, Email Drkorenofir@gmail.comBackground: Studies analyze the degree to which gender-based differences are affected by age and comorbidities show mixed results.Methods: Using a retrospective cohort study, we analyzed 327 consecutive patients who presented to the emergency department (ED) due to Atrial Fibrillation (AF) from 2014 to 2017 with follow-up at one year.Results: Females with AF were older (p < 0.001), with higher Body Mass Indexes (BMI) (p < 0.001), and a higher rate of hypertension (p < 0.001), hyperlipidemia (p = 0.01), diabetes mellitus (p = 0.05), valvular heart disease (p = 0.05), and thyroid dysfunction (18.3% vs 1.8%, p < 0.001). AF males had higher rate of coronary artery disease (p < 0.001) and heart failure with reduced ejection fraction (p < 0.001). Females were managed with rate control medications more frequently than with antiarrhythmic (p < 0.001). After adjusting gender to age and comorbidities, females continued to have higher rates of heart failure hospitalization (Odds Ratio (OR) 2.73 95% Confidence Interval (CI) 1.04– 5.89, P-value < 0.001) and recurrent AF (OR 3.86, P-value=0.02). Thyroid dysfunction and the lack of antiarrhythmic treatments significantly increased the risk of AF (OR 5.95 95% CI 3.15– 9.73, OR 3.42, respectively, P-value < 0.001 for both) regardless of gender. The mortality rate differs only in a sub-group of females ≥ 75 years of age (OR 1.60, P < 0.001).Conclusion: AF males and females differ significantly in baseline characteristics and tend to be treated unnecessarily differently for AF. Heart failure hospitalizations and recurrent AF continued to be associated with female AF patients, even after adjusting gender to age and comorbidities. Thyroid dysfunction and AF treatment may explain the higher rates of recurrent AF in female patients.Keywords: atrial fibrillation, cardioversion, emergency department, MACE, rate control, rhythm control, survival outcomes |
| first_indexed | 2024-12-12T04:14:26Z |
| format | Article |
| id | doaj.art-9629e505639c4e18939e73f16585d5dc |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-12-12T04:14:26Z |
| publishDate | 2022-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-9629e505639c4e18939e73f16585d5dc2022-12-22T00:38:30ZengDove Medical PressVascular Health and Risk Management1178-20482022-05-01Volume 1834735875099Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management?Israeli AGal DYounis AEhrenberg SRozner ETurgeman YNaami ENaami RKoren OAsaf Israeli,1 Danna Gal,1 Autba Younis,2 Scott Ehrenberg,1 Ehud Rozner,3 Yoav Turgeman,1,3 Edmund Naami,4 Robert Naami,5 Ofir Koren1,3 1Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; 2Internal Medicine E, Emek Medical Center, Afula, Israel; 3Heart Institute, Emek Medical Center, Afula, Israel; 4Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA; 5Department of Medicine, University Hospitals Cleveland Medical center, Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Ofir Koren, Heart Institute, Emek Medical Center, 21 Rabin Boulevard, Afula, 1834111, Israel, Tel +972-04-6495585, Email Drkorenofir@gmail.comBackground: Studies analyze the degree to which gender-based differences are affected by age and comorbidities show mixed results.Methods: Using a retrospective cohort study, we analyzed 327 consecutive patients who presented to the emergency department (ED) due to Atrial Fibrillation (AF) from 2014 to 2017 with follow-up at one year.Results: Females with AF were older (p < 0.001), with higher Body Mass Indexes (BMI) (p < 0.001), and a higher rate of hypertension (p < 0.001), hyperlipidemia (p = 0.01), diabetes mellitus (p = 0.05), valvular heart disease (p = 0.05), and thyroid dysfunction (18.3% vs 1.8%, p < 0.001). AF males had higher rate of coronary artery disease (p < 0.001) and heart failure with reduced ejection fraction (p < 0.001). Females were managed with rate control medications more frequently than with antiarrhythmic (p < 0.001). After adjusting gender to age and comorbidities, females continued to have higher rates of heart failure hospitalization (Odds Ratio (OR) 2.73 95% Confidence Interval (CI) 1.04– 5.89, P-value < 0.001) and recurrent AF (OR 3.86, P-value=0.02). Thyroid dysfunction and the lack of antiarrhythmic treatments significantly increased the risk of AF (OR 5.95 95% CI 3.15– 9.73, OR 3.42, respectively, P-value < 0.001 for both) regardless of gender. The mortality rate differs only in a sub-group of females ≥ 75 years of age (OR 1.60, P < 0.001).Conclusion: AF males and females differ significantly in baseline characteristics and tend to be treated unnecessarily differently for AF. Heart failure hospitalizations and recurrent AF continued to be associated with female AF patients, even after adjusting gender to age and comorbidities. Thyroid dysfunction and AF treatment may explain the higher rates of recurrent AF in female patients.Keywords: atrial fibrillation, cardioversion, emergency department, MACE, rate control, rhythm control, survival outcomeshttps://www.dovepress.com/sex-differences-in-atrial-fibrillation-patients-bias-or-proper-managem-peer-reviewed-fulltext-article-VHRMatrial fibrillationcardioversionemergency departmentmacerate controlrhythm controlsurvival outcomes. |
| spellingShingle | Israeli A Gal D Younis A Ehrenberg S Rozner E Turgeman Y Naami E Naami R Koren O Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? Vascular Health and Risk Management atrial fibrillation cardioversion emergency department mace rate control rhythm control survival outcomes. |
| title | Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? |
| title_full | Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? |
| title_fullStr | Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? |
| title_full_unstemmed | Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? |
| title_short | Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? |
| title_sort | sex differences in atrial fibrillation patients bias or proper management |
| topic | atrial fibrillation cardioversion emergency department mace rate control rhythm control survival outcomes. |
| url | https://www.dovepress.com/sex-differences-in-atrial-fibrillation-patients-bias-or-proper-managem-peer-reviewed-fulltext-article-VHRM |
| work_keys_str_mv | AT israelia sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT gald sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT younisa sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT ehrenbergs sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT roznere sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT turgemany sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT naamie sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT naamir sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement AT koreno sexdifferencesinatrialfibrillationpatientsbiasorpropermanagement |