Prospective Assessment of Sex‐Related Differences in Symptom Status and Health Perception Among Patients With Atrial Fibrillation

Blum, Steffen; Muff, Christoph; Aeschbacher, Stefanie; Ammann, Peter; Erné, Paul; Moschovitis, Giorgio; Valentino, Marcello Di; Shah, Dipen; Schläpfer, Jürg; Fischer, Andréas; Merkel, Tamara; Kühne, Michael; Sticherling, Christian; Oßwald, Stefan; Conen, David

doi:10.1161/jaha.116.005401

Cited by 50 publications

(51 citation statements)

References 30 publications

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“…Most patients in the pathological ECG group suffered from AF or utter and the two most frequent mentioned symptoms were palpitations and dyspnoea comparable with studies dealing with symptoms in several thousand AF patients (13)(14)(15)(16). In our cardiac arrhythmia cohort chest pain took the third place of symptoms.…”

Section: Discussionsupporting

confidence: 82%

Prevalence and presentation of patients with the chief complaint “cardiac arrhythmia” – data from a large university emergency department

Novotny¹,

Klein²,

Thienel³

et al. 2020

Preprint

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Background Cardiac arrhythmias (CA) are a common chief complaint that leads to presentation at the emergency department (ED). However, data on the underlying diagnoses in patients with CA is not well studied. Our objective was to analyse the prevalence and clinical presentation of CA in the setting of an interdisciplinary ED.Methods In this retrospective study, we included all patients admitted to our ED in the Ludwig-Maximilian University Hospital in Munich within one year with the chief complaint “cardiac arrhythmia”. Subsequently cardiac rhythm in the 12-lead electrocardiogram (ECG), clinical presentation, therapy performed in the ED and in-hospital care were analyzed.Results A total of 558 out of 36.798 visitors of the ED presented with the chief complaint of CA. 42.3% of these patients indeed showed a pathologic heart rhythm on the initial ECG. The most abundant pathological ECG diagnosis was atrial fibrillation. In the pathological ECG group 60.6% and in the sinus rhythm (SR) group 39.4% of patients had to be admitted to hospital, and 34.7% with pathological ECG underwent invasive investigations (16.8% in the SR group). Conclusion Over half of our patients showed no arrhythmia on the ED ECG. The most abundant arrhythmia was atrial fibrillation. Most of the patients were stable. However, with 49.5% admission rate was quite high. This fact illustrates the need for better outpatient management of these patients. Further chief complaint CA in the ED must not be mistaken as disease specific.

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Section: Discussionsupporting

confidence: 82%

Prevalence and presentation of patients with the chief complaint “cardiac arrhythmia” – data from a large university emergency department

Novotny¹,

Klein²,

Thienel³

et al. 2020

Preprint

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“…Our study further demonstrates that the symptom differences extend to worsened functional capacity among women with AF undergoing ablation. The gender differences in AF catheter ablation rates and reported symptom severity have been well described; however, less has been reported about the severity of symptoms among males and females with AF at the time of catheter ablation and how these symptoms may affect their decision to pursue an invasive rhythm control strategy. In this study, we found that women with AF undergoing catheter ablation reported a much higher symptom burden and more severe functional limitation than men.…”

Section: Discussionmentioning

confidence: 99%

“…6,13,15,16,[20][21][22] Existing literature likewise supports distinctive manifestations of AF symptoms between the sexes. Women with AF have been described to have more frequent and severe symptoms, [23][24][25][26][27] more atypical symptoms, 20,28 and to have a lower quality of life than men with AF. 25,27,29 As such, women have been described to be more likely to seek care for AF.…”

Section: Introductionmentioning

confidence: 99%

Gender differences in symptoms and functional status in patients with atrial fibrillation undergoing catheter ablation

Bazemore

Bolger

Sears

et al. 2018

Pacing Clinical Electrophis

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Background Catheter ablation improves symptoms and quality of life in patients with atrial fibrillation (AF); however, despite its benefit, women are less likely than men to undergo catheter ablation. Women with AF have been described to have more frequent and severe symptoms with a lower quality of life than men, and it is therefore unclear why women are less likely to undergo catheter ablation. We prospectively characterized gender differences in AF symptoms among men and women undergoing ablation at UNC using questionnaire data. Methods Functional capacity was assessed with the Duke Activity Status Index (DASI) and quality of life was assessed with the Canadian Cardiovascular Society Symptoms of AF score (CCS‐SAF) and the AF Effect on Quality‐of‐Life Questionnaire Tool (AFEQT). Results Among 191 patients in the study, women were less likely to undergo catheter ablation and had higher rates of paroxysmal AF and higher CHADS2‐VASc scores than men. Women had a worse functional capacity with significantly lower DASI scores than men; quality of life was also worse among women, with higher CCS‐SAF scores and lower AFEQT scores than men. After adjustment for AF type, there was a persistent gender difference for functional capacity and symptom measures. Conclusions At the time of catheter ablation, women with AF had a significantly lower functional status with worse symptoms and a lower quality of life than men. The role of this symptom difference on the gender gap in enrollment for catheter ablation is unclear and likely due to multiple patient and provider factors.

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“…Furthermore, prior studies have been limited by a narrow description of QOL based on visual analog scales and lack information on patients' concerns or satisfaction after their initial management. 6 Given the rapid increase in the burden of AF in Asian populations, 7 a deeper understanding of their symptom burden, QOL, and satisfaction with treatment is needed. This is of particular importance in Japan, where an aging society, which is more prone to AF, is becoming a public health concern.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Sex Differences in the Initial Symptom Burden, Applied Treatment Strategy, and Quality of Life in Japanese Patients With Atrial Fibrillation

et al. 2019

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IMPORTANCE The clinical characteristics and outcomes of women and men with atrial fibrillation (AF) are reported to be different. However, whether sex-related differences extend to patients' symptom burden and perceived quality of life (QOL) or the management pattern of AF has been rarely studied, particularly in Asian countries. OBJECTIVE To assess the differences in symptoms, treatment, and QOL between Japanese female and male patients with AF. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using data from the multicenter outpatient registry Keio Interhospital Cardiovascular Studies-Atrial Fibrillation (KiCS-AF), which collects information regarding health status and the treatment of patients with newly diagnosed or referred AF. One-year follow-up data were available for 1534 patients at 11 referral centers in the Tokyo, Japan, area who were enrolled between September 2012 and December 2015. All data available up to the 1-year follow-up examination through July 31, 2017, were included. MAIN OUTCOMES AND MEASURES Sex, symptoms, AF treatment, and QOL as determined by Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaires at their initial visit and 1 year later. RESULTS Of 1534 patients, 1076 (70.1%) were men. Compared with men, women were more likely to be older (median age, 73 years [interquartile range {IQR}, 65-78 years] vs 65 years [IQR, 57-73 years], P < .001) and have higher median brain-type natriuretic peptide levels (102.8 pg/mL [IQR, 47.3-235.5 pg/mL] vs 74.1 pg/mL [IQR, 28.5-150.5 pg/mL], P < .001). Women also had lower median AFEQT overall summary scores than men (75 [IQR, 61-85] vs 80 [IQR, 69-90]; P < .001) but similar treatment satisfaction at baseline. During follow-up, women were less likely to be treated with a rhythm control strategy (48.1% [n = 214] vs 58.0% [n = 621], P < .001), including catheter ablation of AF (adjusted hazard ratio, 0.77 [95% CI, 0.62-0.95]; P = .02). At 1-year follow-up, women and men had improved QOL scores, regardless of their baseline characteristics (eg, age or brain-type natriuretic peptide levels) or treatment strategies, yet the sex gap persisted and grew (adjusted change in AFEQT overall summary score during 12 months, 5.89 [95% CI, 2.24-9.54] in women vs 8.94 [95% CI, 5.59-12.30] in men; P = .02). CONCLUSIONS AND RELEVANCE In contemporary Japanese clinical practice among unselected patients with AF, women were initially seen with greater QOL impairment, and the sex gap grew 1 (continued) Key Points Question Are there differences in symptoms, provided care, and quality of life between female and male patients with atrial fibrillation in Japan? Findings This Japanese registry-based cohort study included 1534 new patients referred for the management of atrial fibrillation. Overall, 29.9% (n = 458) were women; although women experienced more atrial fibrillationrelated symptoms and had worse quality of life at baseline, they were less likely to receive rhythm control treatment compared with men, and the gender gap on quality of life tended ...

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Prospective Assessment of Sex‐Related Differences in Symptom Status and Health Perception Among Patients With Atrial Fibrillation

Cited by 50 publications

References 30 publications

Prevalence and presentation of patients with the chief complaint “cardiac arrhythmia” – data from a large university emergency department

Prevalence and presentation of patients with the chief complaint “cardiac arrhythmia” – data from a large university emergency department

Gender differences in symptoms and functional status in patients with atrial fibrillation undergoing catheter ablation

Assessment of Sex Differences in the Initial Symptom Burden, Applied Treatment Strategy, and Quality of Life in Japanese Patients With Atrial Fibrillation

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