title: Differences in Clinical and Functional Outcomes of Atrial Fibrillation in Women and Men: Two-Year Results From the ORBIT-AF Registry.
abstract: Despite the frequency of atrial fibrillation (AF) in clinical practice, relatively little is known about sex differences in symptoms and quality of life and how they may affect treatment and outcomes.
  
  
  
  To determine whether symptoms, quality of life, treatment, and outcomes differ between women and men with AF.
  
  
  
  This observational cohort study included 10 135 patients with AF. The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation is a prospective, nationwide, multicenter outpatient registry of patients with incident and prevalent AF enrolled at 176 sites between June 2010 and August 2011.
  
  
  
  Symptoms, quality of life as measured by Atrial Fibrillation Effects on Quality of Life scores, AF treatment, cardiovascular outcomes, stroke or non-central nervous system embolism, and all-cause mortality.
  
  
  
  Overall, 4293 of the cohort (42%) were female. Compared with men, women were older (77 years; interquartile range [IQR], 69-83, vs 73 years; IQR, 65-80; P < .001) and had higher median CHA2DS2-VASc scores (5; IQR, 4-6, vs 3; IQR, 2-5; P < .001), but less sleep apnea (578 [13.5%] vs 1264 [21.6%]; P < .001). Only 32.1% of women (n = 1378) were asymptomatic (European Heart Rhythm Association class I) compared with 42.5% of men (n = 2483) in unadjusted analyses (P < .001). Women had lower (more severe) unadjusted baseline overall Atrial Fibrillation Effects on Quality of Life scores (n = 2007; 80; IQR, 62-92 vs 83; IQR, 69-94; P < .001). Women had similar rates of anticoagulation and similar time in therapeutic range. In follow-up, women experienced lower risk-adjusted all-cause mortality (adjusted hazard ratio, 0.57; 95% CI, 0.49-0.67) and cardiovascular death (adjusted hazard ratio, 0.56; 95% CI, 0.44-0.72); however, they had a higher risk for stroke or non-central nervous system embolism (adjusted hazard ratio, 1.39; 95% CI, 1.05-1.84; P = .02) compared with men.
  
  
  
  Women with AF have more symptoms and worse quality of life. Despite higher risk, women have lower risk-adjusted all-cause and cardiovascular death compared with men, but higher stroke rates. Future studies should focus on how treatment and interventions specifically affect AF-related quality of life and cardiovascular outcomes in women.
  
  
  
  clinicaltrials.gov Identifier: NCT01165710.
authors.affiliation: Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: DaJuanicia N
authors.initials: DN
authors.lastname: Simon
authors.affiliation: Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Steinberg
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: University of Colorado, Denver.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Division of Cardiology, University of California, Los Angeles.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Bernard
authors.initials: B
authors.lastname: Gersh
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Elaine
authors.initials: E
authors.lastname: Hylek
authors.affiliation: Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: James A
authors.initials: JA
authors.lastname: Reiffel
authors.affiliation: School of Medicine, Penn State University, Hershey, Pennsylvania.
authors.forename: Gerald V
authors.initials: GV
authors.lastname: Naccarelli
authors.affiliation: Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012737:Sex Factors; D016896:Treatment Outcome