title: Hormone replacement therapy and adverse outcomes in women with atrial fibrillation: an analysis from the atrial fibrillation follow-up investigation of rhythm management trial.
abstract: OBJECTIVE
  Hormone replacement therapy (HRT) use has been related to thromboembolism, but whether HRT increases adverse outcomes in females with atrial fibrillation is uncertain.
  
  
  METHODS
  We used the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial data set that included 1594 women (39.3% of the population, mean age 71±8), of whom 376 (23.6%) were taking HRT at baseline. The primary end point, a composite of all-cause death, stroke, systemic/pulmonary embolism, and myocardial infarction, and secondary outcomes (ie, each individual end point) and major bleeding, were considered.
  
  
  RESULTS
  HRT was not independently associated with the primary end point (hazard ratio=0.894; 95% confidence interval, 0.658-1.214; P=0.473) or any secondary outcome. Age (P<0.001), diabetes mellitus (P<0.001), previous stroke (P=0.011), and heart failure (P<0.001) predicted the primary end point. Lack of association between HRT and the primary end point was confirmed in a propensity score-matched control group (hazard ratio=0.966; 95% confidence interval, 0.663-1.409; P=0.858).
  
  
  CONCLUSIONS
  HRT does not independently predict mortality, thromboembolism, or bleeding in a large cohort of women with atrial fibrillation.
authors.affiliation: From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (S.A., G.Y.H.L.); University of Missouri Health Care, Columbia (R.M.S.); and University of Iowa Hospitals and Clinics, Iowa City (B.O.).
authors.forename: Stavros
authors.initials: S
authors.lastname: Apostolakis
authors.affiliation: From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (S.A., G.Y.H.L.); University of Missouri Health Care, Columbia (R.M.S.); and University of Iowa Hospitals and Clinics, Iowa City (B.O.).
authors.forename: Renee M
authors.initials: RM
authors.lastname: Sullivan
authors.affiliation: From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (S.A., G.Y.H.L.); University of Missouri Health Care, Columbia (R.M.S.); and University of Iowa Hospitals and Clinics, Iowa City (B.O.).
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.affiliation: From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (S.A., G.Y.H.L.); University of Missouri Health Care, Columbia (R.M.S.); and University of Iowa Hospitals and Clinics, Iowa City (B.O.). g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057216:Propensity Score; D016016:Proportional Hazards Models
keywords: atrial fibrillation; hormone replacement therapy