Sex Differences in Treatment Strategy and Adverse Events in Older Patients With Atrial Fibrillation

According to a study, published in BMC Cardiovascular Disorders, women with atrial fibrillation (AF) have greater symptomatology, worse quality of life, and a higher risk of stroke compared to men. However, women are less likely to receive rhythm control treatment. Thus, Vinita Subramanya and colleagues examined whether this disparity persists in older patients and whether sex is a factor in the effectiveness of rhythm or rate control therapies.

They reported that sex differences still existed in patients aged 75 years and older, and women were still less likely to receive anticoagulants and rhythm control treatments. Compared to men, women also had a higher risk of heart failure when treated with rhythm control strategies for AF.


The team studied 135,850 men and 139,767 women aged ≥75 years with diagnosed AF. Anticoagulant use included warfarin or a direct oral anticoagulant. Rate control therapies included rate control medication or atrioventricular node ablation. Rhythm control therapies included anti-arrhythmic medication, catheter ablation, or cardioversion. The authors used multivariable models to examine the association between sex and treatment strategy and to determine whether the association between treatment strategies and adverse outcomes, such as bleeding, heart failure, and stroke, differed by sex as well.

At the time of AF diagnoses, the analysis revealed that women were aged an average of 83.8 years (standard deviation [SD], 5.6), while men were aged an average of 82.5 years (SD, 5.2). Women were less likely to receive anticoagulants or a rhythm control treatment. Rhythm control therapy also had a significantly stronger association with risk of heart failure compared to rate control therapy in women than in men (hazard ratios [HRs] = 1.41 for women and 1.21 for men; interaction: p < 0.0001). No sex differences were found for risk of bleeding or stroke.


The authors concluded that “efforts are needed to enhance use AF therapies among women,” and that, “future studies will need to delve into the mechanisms underlying these differences.”