Arrhythmias and Conduction Disturbances
Impact of Gender on the Prognosis of Patients With Nonvalvular Atrial Fibrillation

https://doi.org/10.1016/j.amjcard.2013.11.057Get rights and content

Treatment guidelines for atrial fibrillation (AF) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF (NVAF). The present study aimed to determine the impact of gender on prognosis of Japanese patients with NVAF. A subanalysis of 7,406 patients with NVAF (mean age 70 years) who were followed-up prospectively for 2 years was performed using data from the J-RHYTHM registry. The primary end points were thromboembolic events, major hemorrhaging, total mortality, and cardiovascular mortality. Compared with male subjects (n = 5,241), female subjects (n = 2,165) were older and displayed greater prevalences of paroxysmal AF, heart failure, and hypertension but less prevalences of diabetes, previous cerebral infarction, and coronary artery disease. Male and female patients had mean CHADS2 (Congestive heart failure, Hypertension, Age of 75 years or more, Diabetes mellitus and prior Stroke or transient ischemic attack) scores of 1.6 and 1.8, respectively (p <0.001). Warfarin was given to 87% of male patients and 86% of female patients (p = 0.760), and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline (1.91 vs 1.90, respectively, p = 0.756). Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging (odds ratio 1.59, 95% confidence interval 1.05 to 2.40, p = 0.027) and all-cause mortality (odds ratio 1.78, 95% confidence interval 1.25 to 2.55, p <0.002) but not for thromboembolic events (odds ratio 1.24, 95% confidence interval 0.83 to 1.86, p = 0.297) or cardiovascular mortality (odds ratio 0.96, 95% confidence interval 0.56 to 1.66, p = 0.893). In conclusion, female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin. However, male gender is a risk factor for major hemorrhaging and all-cause mortality.

Section snippets

Methods

The details of the study design,14 the subjects' characteristics,15 and the main analyses16 have been reported elsewhere. Briefly, the study protocol conformed to the Declaration of Helsinki and was approved by each of the participating institutions. Consecutive patients with AF were recruited at the outpatient clinic of each participating institution from January 2009 to July 2009. All the patients gave their written informed consent. Patients who had maintained sinus rhythm for >1 year with

Results

Of the 7,516 patients with NVAF enrolled in the J-RHYTHM registry, 110 (2%) were lost to follow-up. Therefore, the remaining 7,406 patients constituted the study group for this subanalysis (Table 1). There were 5,241 men and 2,165 women in the study population. Compared with male patients with AF, female patients were older and displayed greater prevalences of paroxysmal AF, heart failure and hypertension but less prevalences of diabetes, previous CI or TIA, cardiomyopathy, and coronary artery

Discussion

The present subanalysis of the J-RHYTHM registry,14, 15, 16 in which approximately 86% of the participants received warfarin, revealed the following major findings regarding sex-related differences in the prognosis of Japanese patients with NVAF. Female gender did not emerge as an independent risk factor for thromboembolism. In addition, being an elderly woman of ≥75 years of age was not found to be a risk factor for thromboembolism compared with being an elderly man of the same age. In

Disclosures

Dr. Inoue reports receiving research fund from Boehringer Ingelheim and Daiichi-Sankyo, and remuneration from Daiichi-Sankyo, Bayer Healthcare, and Boehringer Ingelheim; Dr. Atarashi receiving research fund from Daiichi-Sankyo and Boehringer Ingelheim, and lecture fees from Bayer Healthcare and Boehringer Ingelheim; Dr. Okumura receiving research fund from Boehringer Ingelheim and Daiichi-Sankyo, and remuneration from Boehringer Ingelheim, Bayer Healthcare, Daiichi-Sankyo, and Pfizer; Dr.

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    This study was planned by the Japanese Society of Electrocardiology and supported by a grant from the Japan Heart Foundation, Tokyo, Japan.

    This study is registered at UMIN Clinical Trials Registry (UMIN000001569).

    See page 961 for disclosure information.

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