Gender-Based Clinical, Therapeutic Strategies and Prognosis Differences in Atrial Fibrillation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Variables Collected
2.3. Follow-Up
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Study Population
3.2. Gender-Based Clinical Differences at Index Episode
3.3. Healthcare Resource Use and Therapeutic Differences
3.4. Comparison of Long-Term Adverse Events
3.5. Multivariate Analysis of Mortality
4. Discussion
4.1. Possible Mechanisms Involved
4.2. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 2013) | Male (n = 800) | Female (n = 1213) | p-Value | |
---|---|---|---|---|
Demographic data | ||||
Age (years) | 75 ± 12.6 | 70.86 ± 14.1 | 77.8 ± 10.6 | <0.001 |
<65 | 369 (18.3%) | 233 (29.1%) | 136 (11.2%) | |
65–74 | 430 (21.4%) | 172 (21.5%) | 258 (21.3%) | |
75–84 | 744 (37%) | 278 (34.8%) | 466 (38.4%) | |
>85 | 470 (23.3%) | 117 (14.6%) | 353 (29.1%) | |
Comorbidities | ||||
Hypertension | 1530 (76%) | 551 (68.9%) | 979 (80.7%) | <0.001 |
T2DM | 734 (36.46%) | 273 (34.1%) | 461 (38%) | 0.077 |
Smoking | 203 (10.1%) | 162 (20.3%) | 41 (3.4%) | <0.001 |
Obesity | 171 (8.5%) | 55 (6.9%) | 116 (9.6%) | 0.034 |
OSA | 78 (3.9%) | 44 (5.5%) | 34 (2.8%) | 0.002 |
Dyslipidemia | 177 (8%) | 288 (36%) | 513 (42.3%) | 0.005 |
Alcohol abuse | 801 (39.8%) | 29 (3.6%) | 3 (0.2%) | <0.001 |
COPD | 32 (1.6%) | 130 (16.3%) | 47 (3.9%) | <0.001 |
CKD | 231 (11.5%) | 92 (11.5%) | 139 (11.5%) | 0.978 |
PAD | 96 (4.8%) | 58 (7.3%) | 38 (3.1%) | <0.001 |
Stroke | 104 (5.2%) | 81 (10.1%) | 126 (10.4%) | 0.850 |
Structural Heart disease | ||||
HF | 400 (19.9%) | 130 (16.3%) | 270 (22.3%) | 0.001 |
Prior AMI | 158 (7.8%) | 85 (10.6%) | 73 (6%) | <0.001 |
AVD | 157 (7.8%) | 56 (7.0%) | 101 (8.3%) | 0.277 |
MVD | 221 (11%) | 68 (8.5%) | 153 (12.6%) | 0.004 |
DCM | 71 (3.5%) | 49 (6.1%) | 22 (1.8%) | <0.001 |
ICM | 184 (9.1%) | 89 (11.1%) | 95 (7.8%) | 0.012 |
HCM | 95 (4.7%) | 40 (5%) | 55 (4.5%) | 0.630 |
LVEF | 49.43 ± 13.43 | 46.0 ± 14.7 (n = 97) | 52.4 ± 11.4 (n = 111) | 0.001 |
Prior AF known | ||||
AF (all types) | 876 (43.52%) | 316 (39.5%) | 560 (46.2%) | 0.003 |
Paroxysmal | 216 (10.7%) | 78 (9.8%) | 138 (14.4%) | 0.341 |
Persistent | 123 (6.1%) | 48 (6,2%) | 75 (6%) | 0.478 |
Permanent | 204 (10.1%) | 73 (9.1%) | 131 (10.8%) | 0.344 |
CHA2DS2-VASc score | ||||
Average | 2.7 ± 1.6 | 4.2 ± 1.4 | <0.001 | |
HASBLED Scale | ||||
Average | 2.5 ± 1.14 (n = 533) | 2.6 ± 1.01 (n = 332) | 0.578 |
Male (n = 800) | Female (n = 1213) | p-Value | |
---|---|---|---|
Asymptomatic | 72 (9%) | 63 (5.3%) | 0.007 |
Chest pain | 162 (20.3%) | 281 (23.2%) | 0.122 |
Palpitations | 202 (25.3%) | 406 (33.5%) | <0.001 |
HF | 209 (26.1%) | 401 (33.1%) | 0.001 |
APE | 25 (3.1%) | 61 (5%) | 0.039 |
Dizziness | 131 (16.4%) | 165 (13.6%) | 0.086 |
Asthenia | 47 (5.9%) | 94 (7.7%) | 0.107 |
Syncope | 39 (4.9%) | 52 (4.3%) | 0.534 |
Hemodynamic instability | 11 (1.4%) | 31 (2.6%) | 0.070 |
HR at admission | 117.69 ± 34.665 | 122.41 ± 31.333 | 0.002 |
B | SE | Wald | p-Value | HR | 95.0% CI for Exp(B) | ||
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Gender (Female) | 0.297 | 0.118 | 6.287 | 0.012 | 1.346 | 1.067 | 1.697 |
Age | 0.017 | 0.006 | 9.272 | 0.002 | 1.017 | 1.006 | 1.028 |
CKD | −0.310 | 0.151 | 4.222 | 0.040 | 0.733 | 0.546 | 0.986 |
AMI | 0.394 | 0.161 | 5.959 | 0.015 | 1.483 | 1.081 | 2.035 |
Previous HF | 0.561 | 0.118 | 22.460 | 0.000 | 1.753 | 1.390 | 2.211 |
DCM | 0.563 | 0.209 | 7.260 | 0.007 | 1.756 | 1.166 | 2.645 |
HCM | 0.474 | 0.188 | 6.343 | 0.012 | 1.607 | 1.111 | 2.324 |
CHA2DS2-VASc | 0.094 | 0.043 | 4.729 | 0.030 | 1.099 | 1.009 | 1.196 |
Mitral regurgitation | 0.509 | 0.130 | 15.250 | 0.000 | 1.664 | 1.289 | 2.148 |
95.0% CI for Exp(B) | |||||||
---|---|---|---|---|---|---|---|
β | SE | Wald | p-Value | HR | Lower | Upper | |
Age (>75) Gender | 1.545 | 0.100 | 239.132 | <0.001 | 4.689 | 3.855 | 5.703 |
−0.112 | 0.078 | 2.032 | 0.154 | 0.894 | 0.767 | 1.043 | |
HTN | −0.121 | 0.091 | 1.779 | 0.182 | 0.886 | 0.741 | 1.059 |
T2DM | 0.201 | 0.073 | 7.503 | 0.006 | 1.223 | 1.059 | 1.412 |
CKD | 0.406 | 0.094 | 18.453 | <0.001 | 1.501 | 1.247 | 1.806 |
COPD | 0.528 | 0.108 | 23.973 | <0.001 | 1.695 | 1.372 | 2.093 |
PAD | 0.018 | 0.146 | 0.015 | 0.904 | 1.018 | 0.764 | 1.356 |
AMI | 0.405 | 0.120 | 11.493 | 0.001 | 1.500 | 1.186 | 1.895 |
Stroke | 0.438 | 0.099 | 19.478 | <0.001 | 1.550 | 1.276 | 1.882 |
HF | 0.394 | 0.083 | 22.626 | <0.001 | 1.483 | 1.261 | 1.744 |
DCM | 0.383 | 0.165 | 5.378 | 0.020 | 1.467 | 1.061 | 2.028 |
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Quesada, A.; Quesada-Ocete, J.; Quesada-Ocete, B.; del Moral-Ronda, V.; Jiménez-Bello, J.; Rubini-Costa, R.; Lavie, C.J.; Morin, D.P.; de la Guía-Galipienso, F.; Rubini-Puig, R.; et al. Gender-Based Clinical, Therapeutic Strategies and Prognosis Differences in Atrial Fibrillation. J. Cardiovasc. Dev. Dis. 2023, 10, 434. https://doi.org/10.3390/jcdd10100434
Quesada A, Quesada-Ocete J, Quesada-Ocete B, del Moral-Ronda V, Jiménez-Bello J, Rubini-Costa R, Lavie CJ, Morin DP, de la Guía-Galipienso F, Rubini-Puig R, et al. Gender-Based Clinical, Therapeutic Strategies and Prognosis Differences in Atrial Fibrillation. Journal of Cardiovascular Development and Disease. 2023; 10(10):434. https://doi.org/10.3390/jcdd10100434
Chicago/Turabian StyleQuesada, Aurelio, Javier Quesada-Ocete, Blanca Quesada-Ocete, Víctor del Moral-Ronda, Javier Jiménez-Bello, Ricardo Rubini-Costa, Carl J. Lavie, Daniel P. Morin, Fernando de la Guía-Galipienso, Ricardo Rubini-Puig, and et al. 2023. "Gender-Based Clinical, Therapeutic Strategies and Prognosis Differences in Atrial Fibrillation" Journal of Cardiovascular Development and Disease 10, no. 10: 434. https://doi.org/10.3390/jcdd10100434
APA StyleQuesada, A., Quesada-Ocete, J., Quesada-Ocete, B., del Moral-Ronda, V., Jiménez-Bello, J., Rubini-Costa, R., Lavie, C. J., Morin, D. P., de la Guía-Galipienso, F., Rubini-Puig, R., & Sanchis-Gomar, F. (2023). Gender-Based Clinical, Therapeutic Strategies and Prognosis Differences in Atrial Fibrillation. Journal of Cardiovascular Development and Disease, 10(10), 434. https://doi.org/10.3390/jcdd10100434