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Original research article
Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation
  1. Renate B Schnabel1,
  2. Ladislav Pecen2,
  3. Francisco M Ojeda1,
  4. Markus Lucerna3,
  5. Nargiz Rzayeva1,
  6. Stefan Blankenberg1,
  7. Harald Darius4,
  8. Dipak Kotecha5,
  9. Raffaele De Caterina6,7,
  10. Paulus Kirchhof8,9
  1. 1 Department of Cardiology, University Heart Center Hamburg–Eppendorf, German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
  2. 2 Medical Facility Pilsen of Charles University, Pilsen, Czech Republic
  3. 3 Daiichi Sankyo Europe GmbH, Munich, Germany
  4. 4 Department of Cardiology, Angiology, Nephrology and Conservative Intensive Care Medicine, Vivantes Klinikum Neukolln, Berlin, Germany
  5. 5 School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK
  6. 6 G. d’Annunzio University of Chieti–Pescara, Chieti, Italy
  7. 7 Fondazione G. Monasterio, Pisa, Italy
  8. 8 Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trust, Birmingham, UK
  9. 9 AFNET, Münster, Germany
  1. Correspondence to Dr Renate B Schnabel, University Heart Center, Department of General and Interventional Cardiology, Martinistr. 52, 20246 Hamburg, Germany; r.schnabel{at}


Objectives Our objective was to examine gender differences in clinical presentation, management and prognosis of atrial fibrillation (AF) in a contemporary cohort.

Methods In 6412 patients, 39.7% women, of the PREvention oF thromboembolic events – European Registry in Atrial Fibrillation, we examined gender differences in symptoms, risk factors, therapies and 1-year incidence of adverse outcomes.

Results Men with AF were on average younger than women (mean±SD: 70.1±10.7 vs 74.1±9.7 years, p<0.0001). Women more frequently had at least one AF-related symptom at least occasionally compared with men (95.4% in women, 89.8% in men, p<0.0001). Prescription of oral anticoagulation was similar, with an increase of non-vitamin K antagonist oral anticoagulants from 5.9% to 12.6% in women and from 6.2% to 12.6% in men, p<0.0001 for both.

Men were more frequently treated with electrical cardioversion and ablation (20.6% and 6.3%, respectively) than women (14.9% and 3.3%, respectively), p<0.0001. Women had 65% (OR: 0.35; 95% CI (0.22 to 0.56)) lower age-adjusted and country-adjusted odds of coronary revascularisation, 40% (OR: 0.60; (0.38 to 0.93)) lower odds of acute coronary syndrome and 20% (OR: 0.80; (0.68 to 0.96)) lower odds of heart failure at 1 year. There were no statistically significant gender differences in 1-year stroke/transient ischaemic attack/arterial thromboembolism and major bleeding events.

Conclusion In a ‘real-world’ European AF registry, women were more symptomatic but less likely to receive invasive rhythm control therapy such as electrical cardioversion or ablation. Further study is needed to confirm that these differences do not disadvantage women with AF.

  • Atrial fibrillation
  • gender differences
  • European registry

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  • Contributors RBS designed the analysis, interpreted the data and wrote the manuscript. LP designed the analysis, performed the statistical analysis and critically reviewed and revised the manuscript. FMO interpreted the data, wrote parts of the manuscript and critically reviewed the manuscript. ML designed the study, obtained the funding and critically reviewed the manuscript. NR wrote parts of the manuscript, interpreted the data and critically reviewed the manuscript. SB critically reviewed the manuscript. HD critically reviewed the manuscript. DK interpreted the data and critically revised the manuscript. RDC designed the study, obtained the funding and critically reviewed the manuscript. PK interpreted the data, designed the study, obtained the funding and critically reviewed the manuscript.

  • Funding This project has received funding from the European Research Council under the European Union’s Horizon 2020 Research and Innovation Programme (grant agreement number 648131). This work was performed in the context of the Junior Research Alliance symAtrial project funded by the German Ministry of Research and Education (BMBF 01ZX1408A) e:Med – Systems Medicine program (RBS). RBS is funded by Deutsche Forschungsgemeinschaft (German Research Foundation) Emmy Noether Program SCHN 1149/3–1 (RBS). The PREFER in AF registry has been funded by Daiichi Sankyo Europe.

  • Competing interests The PREFER in AF study sponsor via a contract research organisation (SSS International Clinical Research GmbH, Munich, Germany) was Daiichi Sankyo Europe GmbH, Munich. The study has an independent scientific steering committee. RDC reports that his institution received research grant support from Boehringer-Ingelheim, Bayer, Bristol-Myers Squibb/Pfizer and Roche and honoraria for lectures and/or consulting from Boehringer-Ingelheim, Bayer and Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Lilly, AstraZeneca, Merck and Novartis. PK receives further research support from the European Union (grant agreement number 633193 (CATCH ME)), British Heart Foundation (FS/13/43/30324), Medical Research Council (UK), Leducq Foundation, German Centre for Heart Research and several drug and device companies active in atrial fibrillation and has received honoraria from several such companies. He is listed as an inventor on two pending patents (WO 2015140571 and WO 2016012783) filed by the University of Birmingham. DK reports grants from Menarini outside the submitted work but during the conduct of the study and professional development support from Daiichi Sankyo.

  • Ethics approval Approvals were obtained from leading and local ethics committees as required by national regulations in Austria, Germany, Switzerland, Italy, Spain and the UK before the start of enrolment at the sites. For France, no specific approval process was applicable for non-interventional studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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