title: Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation.
abstract: OBJECTIVE
  Sex differences in the epidemiology and clinical management of AF are evident. Of note, females are more symptomatic and if age >65, are at higher risk of thromboembolism if incident AF develops, compared with males.
  
  
  RESULTS
  In an analysis from the dataset of the Euro Observational Research Programme on Atrial Fibrillation (EORP-AF) Pilot survey (n = 3119), we examined sex-related differences in presentation, treatment, and outcome of contemporary patients with AF in Europe.Female subjects were older (P < 0.0001), with a greater proportion aged ≥75 years, with more heart failure and hypertension. Heart failure with preserved ejection fraction was more common in females (P < 0.0001), as was valvular heart disease (P = 0.0003). Females were more symptomatic compared with males with a higher proportion being EHRA Class III and IV (P = 0.0012). The more common symptoms that were more prevalent in females were palpitations (P < 0.0001) and fear/anxiety (P = 0.0007). Other symptoms (e.g. dyspnoea, chest pain, fatigue, etc.) were not different between males and females. Health status scores were significantly lower for females overall, specifically for the psychological and physical domains (both P < 0.0001) but not for the sexual activity domain (P = 0.9023). Females were less likely to have electrical cardioversion (18.9 vs. 25.5%, P < 0.0001), and more likely to receive rate control (P = 0.002). Among patients recruited in hospital and discharged alive (n = 2009), documented contraindications to vitamin K antagonist (VKA) were evident in 23.8% of females. A CHA2DS2-VASc score ≥2 was found in 94.7% of females and 74.6% of males (P < 0.0001), with oral anticoagulants being used in 95.3 and 76.2%, respectively (P < 0.0001). A HAS-BLED score of ≥3 was found in 12.2% of females and 14.5% of males. Independent predictors of VKA use in females on multivariate analysis were CHA2DS2-VASc score (P = 0.0007), lower HAS-BLED score (P = 0.0284), and prosthetic mechanical valves (P = 0.0276).
  
  
  CONCLUSIONS
  The EORP-AF Pilot survey provides contemporary data on sex differences in clinical features and management of AF patients participating in the EORP-AF Pilot registry. Female subjects were older and more symptomatic, compared with males, and were more likely to receive rate control. Also, female patients were at higher stroke risk overall, but oral anticoagulation was used in a high proportion of patients.
authors: University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK g.y.h.lip@bham.ac.uk.
authors: Gregory Y H
authors: GY
authors: Lip
authors: EORP Department, European Society of Cardiology, Sophia Antipolis, France.
authors: Cécile
authors: C
authors: Laroche
authors: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Boriani
authors: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Paolo
authors: P
authors: Cimaglia
authors: Department of Cardiology, Colentina University Hospital, Stefan cel Mare 19-21, Sector 2, Bucharest, Romania.
authors: Gheorghe-Andrei
authors: GA
authors: Dan
authors: Cardiovascular Department, S. Filippo Neri Hospital Rome, Rome, Italy.
authors: Massimo
authors: M
authors: Santini
authors: Department of Cardiology, Silesian Center for Heart Disease, ul. M Curie-Sklodowskiej 9, 41-800 Zabrze, Poland.
authors: Zbigniew
authors: Z
authors: Kalarus
authors: Department of Cardiology, Aalborg University Hospital and Aalborg Thrombosis Research Unit, DK-9000 Aalborg, Denmark Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Sondre Skovvej 15, DK-9000 Aalborg, Denmark.
authors: Lars Hvilsted
authors: LH
authors: Rasmussen
authors: Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Oradea, Romania.
authors: Mircea Ioachim
authors: MI
authors: Popescu
authors: Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Oradea, Romania.
authors: Otilia
authors: O
authors: Tica
authors: Department of Cardiology, Aalborg University Hospital and Aalborg Thrombosis Research Unit, DK-9000 Aalborg, Denmark Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Sondre Skovvej 15, DK-9000 Aalborg, Denmark.
authors: Camilla Fragtrup
authors: CF
authors: Hellum
authors: Department of Cardiology, Aalborg University Hospital and Aalborg Thrombosis Research Unit, DK-9000 Aalborg, Denmark Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Sondre Skovvej 15, DK-9000 Aalborg, Denmark.
authors: Bettina
authors: B
authors: Mortensen
authors: Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
authors: Luigi
authors: L
authors: Tavazzi
authors: EORP Department, European Society of Cardiology, Sophia Antipolis, France.
authors: Aldo P
authors: AP
authors: Maggioni
mesh_terms: D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017115:Catheter Ablation / Q000706:statistics & numerical data; D015984:Causality; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D004554:Electric Countershock / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D016387:Women's Health / Q000706:statistics & numerical data
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Female; Survey