Objective To assess whether women with atrial fibrillation (AF) have a higher risk of adverse events than men during long-term follow-up since controversial data have been published.
Methods In the context of two very similar observational multicentre cohort studies, we prospectively followed 3894 patients (28% women) with previously documented AF for a median of 4.02 (3.00–5.83) years. The primary outcome was a composite of ischaemic stroke, myocardial infarction and cardiovascular death. Secondary outcomes included the individual components of the composite outcome, hospitalisation for heart failure, major and clinically relevant non-major bleeding, stroke or systemic embolism and non-cardiovascular death.
Results Mean age was 73.1 years in women vs 70.8 years in men. The incidence of the primary endpoint in women versus men was 2.46 vs 3.24 per 100 patient-years, respectively (adjusted HR (aHR) 0.74, 95% CI 0.58 to 0.94; p=0.01). Women died less frequently from cardiovascular (aHR 0.57, 95% CI 0.41 to 0.78; p<0.001) and non-cardiovascular causes (aHR 0.68, 95% CI 0.47 to 0.98; p=0.04). There were no significant sex-specific differences in stroke (incidence 1.05 vs 1.00; aHR 1.02, 95% CI 0.70 to 1.49, p=0.93), myocardial infarction (incidence 0.67 vs 0.72; aHR 0.98, 95% CI 0.61 to 1.57, p=0.94), major and clinically relevant non-major bleeding (incidence 4.51 vs 4.34; aHR 0.95, 95% CI 0.79 to 1.15, p=0.63) or heart failure hospitalisation (incidence 3.28 vs 3.07; aHR 1.06, 95% CI 0.85 to 1.32, p=0.60).
Conclusion In this large study of patients with established AF, women had a lower risk of death than men, but there were no sex-specific differences in other adverse outcomes.
- atrial fibrillation
- outcome assessment
- risk factors
Data availability statement
No data are available.
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SE-D and SA are joint first authors.
Presented at This paper has previously been presented by SE-D as an abstract at the Joint Annual Meeting of the Swiss Society of Cardiology (SSC) and the Swiss Society of Cardiac and Thoracic Vascular Surgery (SSCC) 9–11 June 2021.
Collaborators All Swiss-AF and Beat-AF investigators are listed in the supplement.
Contributors Conception and design—DC, SE-D, SA, MK and SO. Analysis and interpretation of the data—SA, SE-D, EH, DC and MC; all authors provided input in the interpretation of the data. Drafting of the manuscript—SE-D, SA and DC. Critical revision for important intellectual content—all authors. Final approval of the manuscript—all authors. Guarantor—DC.
Funding The Beat-AF Study was supported by the Swiss National Science Foundation (grant number PP00P3_159322), the Swiss Heart Foundation, the University of Basel, Boehringer Ingelheim, SanofiAventis, Merck Sharp & Dome, Bayer, Daiichi-Sankyo and Pfizer/Bristol-Myers Squibb. The Swiss-AF cohort study is supported by grants of the Swiss National Science Foundation (grant numbers 33CS30_148474 and 33CS30_177520), the Foundation for Cardiovascular Research Basel and the University of Basel.
Disclaimer None of the funders had any role in manuscript preparation or in the decision to submit the manuscript for publication.
Competing interests CSM-Z reports a research grant from Medtronic and speaker fees from Vifor Pharma and Novartis. DC has received consultant/speaker fees from Servier Canada and Roche Diagnostics, outside of the submitted work. GM has received consultant fees for taking part in advisory boards from Novartis, AstraZeneca, Bayer and Böhringer Ingelheim, outside of the submitted work. JHB reports grants from the Swiss National Foundation of Science, the Swiss Heart Foundation, grants from Bayer, lecture fees from Sanofi Aventis and Amgen, to the institution outside the submitted work. LHB received grants from the Swiss National Science Foundation (PBBSB-116873, 33CM30-124119, 32003B-156658; Bern, Switzerland), the Swiss Heart Foundation (Bern, Switzerland, and the University of Basel (Basel, Switzerland). LHB has received an unrestricted research grant from AstraZeneca, and consultancy or advisory board fees or speaker’s honoraria from Amgen, Bayer, Bristol-Myers Squibb, and Claret Medical, and travel grants from AstraZeneca and Bayer. MK reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, grants from Bayer, grants from Pfizer BMS, grants from Boston Scientific and grants from Daiichi Sankyo. He is supported by the Swiss National Science Foundation (32473B_176178) and the Swiss Heart Foundation. NR received a grant from the Swiss Heart Foundation. RK receives institutional grants from Abbott, Biosense-Webster, Boston-Scientific, Biotronik, Medtronic and Sis-Medical.
Provenance and peer review Not commissioned; externally peer reviewed.
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