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Sex-related differences in atrial fibrillation: can we discern true disparities from biases?
  1. Tatjana S Potpara1,2,
  2. Carina Blomstrom-Lundqvist3
  1. 1 School of Medicine, Belgrade University, Belgrade, Serbia
  2. 2 Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
  3. 3 Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Tatjana S Potpara, Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Visegradska 26, Belgrade 11000, Serbia; tatjana.potpara{at}mfub.bg.ac.rs

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The deleterious health effects of atrial fibrillation (AF), including impaired quality of life and significantly increased risks of stroke, heart failure and all-cause mortality, can be attenuated using the therapies for AF symptoms management and/or reduction in adverse cardiovascular outcomes. As certain consistently reported sex-related differences in the epidemiology, pathophysiology, clinical presentation and prognosis of AF (table 1)1–3 may affect ultimate effectiveness of AF treatment, these differences should be well appreciated in the personalised, individual patient-centred approach to AF management in clinical practice.

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Table 1

Sex-related differences in the epidemiology, pathophysiology, clinical presentation and prognosis of atrial fibrillation, and sex-related differences in utilisation and outcomes of AF-directed therapies1 3 4 6–8

In this issue, Schnabel et al 4 describe sex-related differences in clinical presentation and 1-year outcomes in a prospective industry-sponsored registry of 6412 patients with AF (39.7% female) across seven Western European countries (France, Germany, Austria, Switzerland, Italy, Spain and the UK), mostly managed by cardiologists (89% of study participants). The study addressed a number of clinically relevant sex-related issues in patients with AF.

For instance, the extensively debated contribution of female sex to AF-related stroke risk has been eventually acknowledged in most of the international AF guidelines recommending the CHA2DS2-VASc score (where Sc is for sex, and being female scores 1 point) as the tool for stroke risk assessment. Although numerous observational studies of different patient populations with variable follow-up inconsistently reported female sex as a multivariable AF-related …

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