Differences in clinical and functional outcomes of atrial fibrillation in women and men: Two-year results from the ORBIT-AF Registry

Jonathan P. Piccini, Da Juanicia N. Simon, Benjamin A. Steinberg, Laine Thomas, Larry A. Allen, Gregg C. Fonarow, Bernard Gersh, Elaine Hylek, Peter R. Kowey, James A. Reiffel, Gerald V. Naccarelli, Paul S. Chan, John A. Spertus, Eric D. Peterson

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

IMPORTANCE: 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. OBJECTIVE: To determine whether symptoms, quality of life, treatment, and outcomes differ between women and men with AF. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMESAND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: Women withAFhave 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.

Original languageEnglish (US)
Pages (from-to)282-291
Number of pages10
JournalJAMA cardiology
Volume1
Issue number3
DOIs
StatePublished - Jun 2016

Fingerprint

Atrial Fibrillation
Registries
Quality of Life
Embolism
Nervous System
Stroke
Mortality
Sleep Apnea Syndromes
Sex Characteristics
Observational Studies
Cause of Death
Cohort Studies
Outpatients
Therapeutics
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Piccini, J. P., Simon, D. J. N., Steinberg, B. A., Thomas, L., Allen, L. A., Fonarow, G. C., ... Peterson, E. D. (2016). Differences in clinical and functional outcomes of atrial fibrillation in women and men: Two-year results from the ORBIT-AF Registry. JAMA cardiology, 1(3), 282-291. https://doi.org/10.1001/jamacardio.2016.0529
Piccini, Jonathan P. ; Simon, Da Juanicia N. ; Steinberg, Benjamin A. ; Thomas, Laine ; Allen, Larry A. ; Fonarow, Gregg C. ; Gersh, Bernard ; Hylek, Elaine ; Kowey, Peter R. ; Reiffel, James A. ; Naccarelli, Gerald V. ; Chan, Paul S. ; Spertus, John A. ; Peterson, Eric D. / Differences in clinical and functional outcomes of atrial fibrillation in women and men : Two-year results from the ORBIT-AF Registry. In: JAMA cardiology. 2016 ; Vol. 1, No. 3. pp. 282-291.
@article{5604834f831f4372b9ef07e55627c36b,
title = "Differences in clinical and functional outcomes of atrial fibrillation in women and men: Two-year results from the ORBIT-AF Registry",
abstract = "IMPORTANCE: 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. OBJECTIVE: To determine whether symptoms, quality of life, treatment, and outcomes differ between women and men with AF. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMESAND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: Women withAFhave 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.",
author = "Piccini, {Jonathan P.} and Simon, {Da Juanicia N.} and Steinberg, {Benjamin A.} and Laine Thomas and Allen, {Larry A.} and Fonarow, {Gregg C.} and Bernard Gersh and Elaine Hylek and Kowey, {Peter R.} and Reiffel, {James A.} and Naccarelli, {Gerald V.} and Chan, {Paul S.} and Spertus, {John A.} and Peterson, {Eric D.}",
year = "2016",
month = "6",
doi = "10.1001/jamacardio.2016.0529",
language = "English (US)",
volume = "1",
pages = "282--291",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
number = "3",

}

Piccini, JP, Simon, DJN, Steinberg, BA, Thomas, L, Allen, LA, Fonarow, GC, Gersh, B, Hylek, E, Kowey, PR, Reiffel, JA, Naccarelli, GV, Chan, PS, Spertus, JA & Peterson, ED 2016, 'Differences in clinical and functional outcomes of atrial fibrillation in women and men: Two-year results from the ORBIT-AF Registry', JAMA cardiology, vol. 1, no. 3, pp. 282-291. https://doi.org/10.1001/jamacardio.2016.0529

Differences in clinical and functional outcomes of atrial fibrillation in women and men : Two-year results from the ORBIT-AF Registry. / Piccini, Jonathan P.; Simon, Da Juanicia N.; Steinberg, Benjamin A.; Thomas, Laine; Allen, Larry A.; Fonarow, Gregg C.; Gersh, Bernard; Hylek, Elaine; Kowey, Peter R.; Reiffel, James A.; Naccarelli, Gerald V.; Chan, Paul S.; Spertus, John A.; Peterson, Eric D.

In: JAMA cardiology, Vol. 1, No. 3, 06.2016, p. 282-291.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Differences in clinical and functional outcomes of atrial fibrillation in women and men

T2 - Two-year results from the ORBIT-AF Registry

AU - Piccini, Jonathan P.

AU - Simon, Da Juanicia N.

AU - Steinberg, Benjamin A.

AU - Thomas, Laine

AU - Allen, Larry A.

AU - Fonarow, Gregg C.

AU - Gersh, Bernard

AU - Hylek, Elaine

AU - Kowey, Peter R.

AU - Reiffel, James A.

AU - Naccarelli, Gerald V.

AU - Chan, Paul S.

AU - Spertus, John A.

AU - Peterson, Eric D.

PY - 2016/6

Y1 - 2016/6

N2 - IMPORTANCE: 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. OBJECTIVE: To determine whether symptoms, quality of life, treatment, and outcomes differ between women and men with AF. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMESAND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: Women withAFhave 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.

AB - IMPORTANCE: 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. OBJECTIVE: To determine whether symptoms, quality of life, treatment, and outcomes differ between women and men with AF. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMESAND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: Women withAFhave 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.

UR - http://www.scopus.com/inward/record.url?scp=84991569692&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991569692&partnerID=8YFLogxK

U2 - 10.1001/jamacardio.2016.0529

DO - 10.1001/jamacardio.2016.0529

M3 - Article

C2 - 27438106

AN - SCOPUS:84991569692

VL - 1

SP - 282

EP - 291

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 3

ER -