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