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Original research article
Association of sex and atrial fibrillation therapies with patient-reported outcomes
  1. Kelly Therese Gleason1,
  2. Cheryl Renee Dennison Himmelfarb1,
  3. Daniel Ernest Ford1,
  4. Harold Lehmann1,
  5. Laura Samuel1,
  6. Sandeep Jain2,
  7. Gerald Naccarelli3,
  8. Vikas Aggarwal4,
  9. Saman Nazarian5
  1. 1 School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Heart and Vascular Institute, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3 Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
  4. 4 Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Harbor, Michigan, USA
  5. 5 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Kelly Therese Gleason, School of Nursing, Johns Hopkins University, Baltimore, MD 21218, USA; kgleaso2{at}


Objectives Women report higher atrial fibrillation (AF) symptom severity and receive less AF therapies than their male counterparts. It is understudied if differences in AF therapies received explains sex differences in AF symptom severity. We investigate the impact of sex and AF therapies on patient-reported outcomes.

Methods Participants were recruited (n=953) across four academic medical centres with an AF diagnosis and age ≥18 years. Patient-reported outcomes (AF symptom severity, AF-related quality of life, functional status and emotional status) were determined by biannual surveys. We performed multiple linear regressions on propensity-matched cohorts to determine the association of AF therapies and sex on patient-reported outcomes.

Results Our study population (n=953) was 65% male (n=616), 93% white (n=890) and 72 (±10) years old. Individuals receiving rate control therapy reported comparatively lower AF-related quality of life (−7.22, 95% CI −11.51 to –2.92) and poorer functional status (−3.69, 95% CI −5.27 to –2.12). Individuals receiving rhythm control strategies did not report significantly different patient-reported outcomes. Women were more likely to report poorer functional status (−2.63, 95% CI −3.86 to –1.40) and poorer AF-related quality of life, higher anxiety (2.33, 95% CI 1.07 to 3.59), higher symptoms of depression (1.48, 95% CI 0.31 to 2.65) and AF symptom severity (0.29, 95% CI 0.07 to 0.52).

Conclusions Female sex was associated with comparatively poorer AF symptom severity and quality of life, and this association remained after accounting for AF therapies received. Receiving rate control medication alone was associated with comparatively poorer AF-related quality of life and functional status.

  • atrial fibrillation
  • electronic medical records
  • health care delivery
  • quality and outcomes of care
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  • Contributors KG originated the concept of the manuscript and led the writing of the manuscript. HL and LS advised on the statistical analyses and contributed to the interpretation of the findings of the manuscript. HL advised and contributed to the data management and quality. DEF and CRDH advised and contributed to the design and interpretation of the findings. SN, SJ, GN and VA advised and contributed to the design of the analyses and interpretation of the findings as expert cardiologists. All authors have read and approved the manuscript.

  • Funding KTG received support from predoctoral fellowship in Interdisciplinary Training in Cardiovascular Health Research, T32 NR012704, and Predoctoral Clinical Research Training Program, TL1 TR001078. This publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (PCORI CDRN #1306-04912) for development of the National Patient-Centered Clinical Research Network, known as PCORnet.

  • Competing interests SN is a scientific advisor to Biosense Webster, Siemens, Imricor and CardioSolv Inc and principal investigator for research funding to the University of Pennsylvania from Biosense Webster, Siemens and Imricor Inc. SJ receives research support from Medtronic and is a principal investigator for research funding to the University of Pittsburgh from Medtronic, Boston Scientific and St. Jude Medical. GN receives research support from Janssen and serves as a scientific advisor to Janssen, Milestone, Omeicos, Glaxo-Smith-Kline and Aceion.

  • Ethics approval The University of Pittsburgh/University of Pittsburgh Medical Center, Penn State College of Medicine, Temple University Hospital and Johns Hopkins University AF cohort study was approved by the Institutional Review Board (JHU IRB00064600).

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

  • Patient consent for publication Not required.

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