Women hospitalized with atrial fibrillation: Gender differences, trends and outcome from a 20-year registry in a middle eastern country (1991–2010)

https://doi.org/10.1016/j.ijcard.2012.10.041Get rights and content

Abstract

Background

Most of the published research on atrial fibrillation (AF) is limited to studies in the developed world and included mainly Caucasian patients. Data about women with AF among other ethnicities is very limited.

Objectives

The aim of this study was to compare the clinical characteristics, treatment and outcome of women to men hospitalized with AF in a middle-eastern country.

Methods

Retrospective analysis of prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Clinical characteristics, management, and outcomes of AF patients were compared according to gender.

Results

During the 20-years period; 1417 women and 2432 men were hospitalized for AF. Women were 5 years older and more likely to have diabetes mellitus, hypertension, and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men. There was no gender preference in the use of anticoagulation. The prevalence of concomitant ischemic heart disease and hypertension increased, while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period. In-hospital mortality and stroke rates were comparable between the two groups.

Conclusions

Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas, mortality and stroke rates were comparable.

Introduction

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice accounting for approximately one-third of hospitalizations for cardiac rhythm disturbances [1], [2]. While there are an increasing number of studies addressing the issue of gender differences in other cardiovascular diseases particularly coronary artery disease [3], [4], nonetheless, only few studies have dealt with gender differences and AF [5], [6], [7], [8], [9], [10], [11], [12], [13], [14].

Some studies suggested less favorable outcomes with higher relative mortality, a higher risk of stroke and an underuse of anticoagulants in women [15], [16], [17], [18], [19]. However, results from these studies were not consistent and included relatively small numbers of women over a short time period. Moreover, to date most of the previously published studies were limited by the fact that they were conducted in the developed world and included mainly Caucasian patients. Data about women with atrial fibrillation among other ethnicities are very limited. Data on nonblack minorities are even scarcer. The current study extends these observations in unique ethnicities that have not been adequately studied previously; (middle eastern Arabs and south Asians) and reports for the first time secular trends of patients hospitalized with AF according to gender over a 20-year period.

Section snippets

Study setting

Qatar is a small Arab country with a population of around 600,000 (2001 Census) and 1.6 million (2010 Census), consisting of Qatari and other middle-eastern Arabs (less than 40%) as well as other ethnic groups. The vast majority of non-Arabs are south Asians mainly from India, Pakistan, Nepal and Bangladesh. This study is based at Hamad General Hospital, Doha, Qatar. This hospital provides inpatient and outpatient medical and surgical care for the residents of Qatar; nationals and expatriates

Results

Overall, from the year 1991 to end of 2010, a total of 41,438 patients with acute cardiac disease were hospitalized. 3849 of patients were admitted with AF and 37,589 patients were admitted with other cardiovascular diagnoses and no-AF. Among AF patients; 1417 (36.8%) were women and 2432 (63.2%) were men.

Discussion

The current study demonstrates for the first time 20-year observations of the clinical characteristics, treatment and outcome of patients hospitalized with AF according to gender. Consistent with reports from the developed world, women were older and more likely to have cardiovascular risk factors including diabetes mellitus, hypertension and chronic renal impairment. Rheumatic heart disease was more common among women, while prior history of myocardial infarction was more common among men. The

Conclusions

The results of this 20-year observational study in residents of a middle-eastern country provide for the first time insights into the characteristics, treatment practices, and in-hospital outcome among middle-eastern Arab and south Asian ethnicities. To the best of our knowledge the current study is the first ever report of gender trends in etiologies of AF over a 20-year period. The current study also underscores the urgent need to study gender differences in atrial fibrillation among various

Acknowledgments

We wish to acknowledge the members of the Department of Cardiology and Cardiovascular Surgery at Hamad Medical Corporation (HMC) for collecting and cleaning data for the analysis and thank the Medical Research Center and its Research Committee at HMC for providing ethical approval of this study. The study was supported by the Medical Research Center, HMC in Qatar. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International

References (44)

  • G.Y. Lip

    Stroke in atrial fibrillation: epidemiology and thromboprophylaxis

    J Thromb Haemost

    (2011)
  • F. Khairallah et al.

    Epidemiology and determinants of outcome of admissions for atrial fibrillation in the United States from 1996 to 2001

    Am J Cardiol

    (2004)
  • Y. Miyasaka et al.

    Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study

    J Am Coll Cardiol

    (2007)
  • V.L. Roger et al.

    American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association

    Circulation

    (2012)
  • J.P. Piccini et al.

    Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007

    Circ Cardiovasc Qual Outcomes

    (2012)
  • A. Simmons et al.

    Coronary artery disease in women: a review and update

    Rev Cardiovasc Med

    (2011)
  • L. Pilote et al.

    A comprehensive view of sex-specific issues related to cardiovascular disease

    CMAJ

    (2007)
  • P.E. Wändell

    Five-year mortality in men and women with atrial fibrillation

    Scand J Prim Health Care

    (2001)
  • M.C. Fang et al.

    Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study

    Circulation

    (2005)
  • V. Essebag et al.

    Sex differences in the relationship between amiodarone use and the need for permanent pacing in patients with atrial fibrillation

    Arch Intern Med

    (2007)
  • J. Roquer et al.

    Comparison of the impact of atrial fibrillation on the risk of early death after stroke in women versus men

    J Neurol

    (2006)
  • G.B. Forleo et al.

    Gender-related differences in catheter ablation of atrial fibrillation

    Europace

    (2007)
  • Cited by (0)

    View full text