Atrial fibrillation in women: treatment

Abstract

Sex-specific differences in the epidemiology, pathophysiology, presentation, prognosis, and treatment of atrial fibrillation (AF) are increasingly recognized. Women with AF generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. Effective treatment of the arrhythmia in women is critical to reduce the rate of adverse events. We review the current evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy. In addition, we provide a critical evaluation of potential disparities and biases in health-care use that might be associated with differences in the outcomes between women and men. We underscore current knowledge gaps that need to be addressed in future studies to improve the management of AF in women. In particular, we suggest several strategies to produce high-quality evidence from randomized clinical trials for women with AF.

Figure 1. Overview of treament of atrial fibrillation in women compared with in men

A summary of the major findings for each aspect covered in this Review. NOAC, non-vitamin K antagonist oral anticoagulant.

Figure 2. Three-tiered framework for sex-specific analysis of observational studies

A tiered pyramid depicting the concepts of difference, disparity, and bias. Red arrows indicate steps that might need intervention.

Figure 3. Participation of women in anticoagulation trials for stroke prevention in atrial fibrillation

A pie chart showing proportion of women (blue) represented in anticoagulation trials compared with men (orange). The numbers indicate the year of publication of the study. The sizes of the individual pie charts correspond to the relative overall size of the trial.