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Original research
Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure
  1. Laura Ueberham1,
  2. Sebastian König1,
  3. Sven Hohenstein2,
  4. Rene Mueller-Roething2,
  5. Michael Wiedemann3,
  6. Anja Schade4,
  7. Melchior Seyfarth5,
  8. Armin Sause5,
  9. Hans Neuser6,
  10. Alexander Staudt7,
  11. Udo Zacharzowsky8,
  12. Christopher Reithmann9,
  13. Dong-In Shin10,
  14. Rene Andrie11,
  15. Ulrike Wetzel12,
  16. Jürgen Tebbenjohanns13,
  17. Carsten Wunderlich14,
  18. Ralf Kuhlen15,
  19. Gerhard Hindricks,
  20. Andreas Bollmann
  21. on behalf of the Helios Electrophysiology Specialty Group
  1. 1 Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
  2. 2 Leipzig Heart Institute, Leipzig, Germany
  3. 3 Department of Cardiology, HELIOS Hospital Berlin-Buch, Berlin, Germany
  4. 4 Department of Cardiology, HELIOS Hospital Erfurt, Erfurt, Thüringen, Germany
  5. 5 Department of Cardiology, HELIOS University Hospital Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany
  6. 6 Department of Internal Medicine II, HELIOS Vogtland Hospital Plauen, Plauen, Sachsen, Germany
  7. 7 Department of Cardiology and Angiology, HELIOS Hospital Schwerin, Schwerin, Germany
  8. 8 Department of Cardiology, HELIOS Hospital Bad Saarow, Bad Saarow, Brandenburg, Germany
  9. 9 Department of Internal Medicine I, HELIOS Hospital München West, München, Germany
  10. 10 Department of Cardiology, HELIOS Hospital Krefeld, Krefeld, Nordrhein-Westfalen, Germany
  11. 11 Department of Cardiology, HELIOS Hospital Siegburg, Siegburg, Nordrhein-Westfalen, Germany
  12. 12 Department of Cardiology, HELIOS Hospital Aue, Aue, Sachsen, Germany
  13. 13 Department of Cardiology, HELIOS Hospital Hildesheim, Hildesheim, Niedersachsen, Germany
  14. 14 Department of Internal Medicine II, HELIOS Hospital Pirna, Pirna, Sachsen, Germany
  15. 15 HELIOS Health GmbH, Berlin, Germany
  1. Correspondence to Dr Laura Ueberham, Electrophysiology, Heart Center Leipzig, Leipzig, Germany; uelaura{at}


Objective Atrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.

Methods Using International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality.

Results Of 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA.

Conclusions There are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice.

  • Catheter ablation
  • sex differences
  • heart failure
  • arrhythmia
  • atrial fibrillation

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  • Contributors Study design and conception: LU, SK, RK, GH and AB. Data acquisition and data transfer: LU, SK, RM-R, MW, AnS, MS, ArS, HN, AlS, UZ, CR, D-IS, RA, UW, JT and CW. Statistical analysis: LU, SK and AB. Manuscript compilation: LU. Manuscript revision: LU, SH, SK, AB, GH and RK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GH is receiving grants through the Leipzig Heart Institute from Boston Scientific (Boston Scientific Corporation, Marlborough, Massachusetts, USA) and Abbott/St. Jude Medical (Abbott Laboratories, Chicago, Illinois, USA), no personal payments are to declare. JT is receiving personal fees from Medtronic (Medtronic plc, Minneapolis, Minnesota, USA). The other authors state that there is no conflict of interest.

  • Patient consent for publication Not required.

  • Ethics approval Use of routine data was approved by the ethical review board of the University of Leipzig (128/17-ek).

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

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.