Association of sex and atrial fibrillation therapies with patient-reported outcomes

Abstract

ObjectivesWomen report higher atrial fibrillation (AF) symptom severity and receive less AF therapies than their male counterparts. It is understudied if differences in AF therapies received explains sex differences in AF symptom severity. We investigate the impact of sex and AF therapies on patient-reported outcomes.MethodsParticipants were recruited (n=953) across four academic medical centres with an AF diagnosis and age ≥18 years. Patient-reported outcomes (AF symptom severity, AF-related quality of life, functional status and emotional status) were determined by biannual surveys. We performed multiple linear regressions on propensity-matched cohorts to determine the association of AF therapies and sex on patient-reported outcomes.ResultsOur study population (n=953) was 65% male (n=616), 93% white (n=890) and 72 (±10) years old. Individuals receiving rate control therapy reported comparatively lower AF-related quality of life (−7.22, 95% CI −11.51 to –2.92) and poorer functional status (−3.69, 95% CI −5.27 to –2.12). Individuals receiving rhythm control strategies did not report significantly different patient-reported outcomes. Women were more likely to report poorer functional status (−2.63, 95% CI −3.86 to –1.40) and poorer AF-related quality of life, higher anxiety (2.33, 95% CI 1.07 to 3.59), higher symptoms of depression (1.48, 95% CI 0.31 to 2.65) and AF symptom severity (0.29, 95% CI 0.07 to 0.52).ConclusionsFemale sex was associated with comparatively poorer AF symptom severity and quality of life, and this association remained after accounting for AF therapies received. Receiving rate control medication alone was associated with comparatively poorer AF-related quality of life and functional status.

Sex-specific and gender-specific aspects in patient-reported outcomes

“…43 Similarly, in cardiovascular assessments, comparative PROMs for patients with atrial fibrillation showed a sex/gender imbalance with women reporting more severe perception of symptoms, poorer quality of life and increased symptoms of anxiety and depression. 44 While one can postulate that physical and psychological symptoms are intertwined in this cardiac population, the reasons for the sex/gender imbalance demonstrated in this study remained unclear.…”

Effectiveness and safety of atrial fibrillation ablation in females

“…Previous studies indicated that females were more likely to be symptomatic from AF than males, 22,23 and that the sex differences in reporting symptoms remained or even increased after receiving AF therapies 24 . A recent European registry study found that females were more symptomatic and consulted more frequently postablation compared to males, despite a similar AF recurrence rates between sexes 10 .…”

Factors Influencing Sex-Related Differences in the Quality of Life of Patients With Atrial Fibrillation: A Systematic Review

“…An overall AFEQT score is calculated using the first three domains to obtain an overall score ranging from 0 (best health status) to 100 (extreme disability). All studies reviewed have suggested that female patients have a significantly lower QoL as assessed by the AFEQT scores [14][15][16][17]. Li [17].…”

“…In the Framingham Heart study that observed 50-year trends in AF data and evaluated 202,417 person-years, it was reported that 74% of women with AF were over the age of 70 years compared to only 58% of men [8]. [16]. This suggests that worse QoL outcomes in female patients despite the older age demographic may be due to general musculoskeletal frailty or a longer time period to acquire a higher burden of co-morbidities.…”

“…The lower QoL in female patients may also be explained by their higher symptom burden [14][15][16][17][18][19][20]. One of the scores recommended to evaluate AF related symptoms is the EHRA scale [28].…”