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. 2024 Dec 1;41(1):e13195.
doi: 10.1002/joa3.13195. eCollection 2025 Feb.

Sex differences in atrial fibrillation in India: Insights from the Kerala-AF registry

Peter Calvert  1 , Yang Chen  1 , Ying Gue  1 , Dhiraj Gupta  1 , Jinbert Lordson Azariah  2   3 , A George Koshy  4 , Geevar Zachariah  5 , K U Natarajan  6 , Gregory Y H Lip  1   7 , Bahuleyan Charantharayil Gopalan  8 ; Kerala AF Registry Investigators
Collaborators, Affiliations

Sex differences in atrial fibrillation in India: Insights from the Kerala-AF registry

Peter Calvert et al. J Arrhythm. .

Abstract

Background: Much data informing sex differences in atrial fibrillation (AF) comes from Western cohorts. In this analysis, we describe sex differences in Kerala, India, using the Kerala-AF registry-the largest AF registry from the Indian subcontinent.

Methods: Patients aged ≥18 years were recruited from 53 hospitals across Kerala. Patients were compared for demographics, treatments, and 12-month outcomes, including major adverse cardiovascular events (MACE) and bleeding.

Results: Male patients were more likely to have a smoking and/or alcohol history and had more ischaemic heart disease (46.2% vs. 25.5%; p < 0.001). Female patients had more valvular AF (35.1% vs. 18.0%; p < 0.001), and more use of calcium-channel blockers (23.3% vs. 16.5%; p < 0.001) or digoxin (39.6% vs. 28.5%; p < 0.001). Almost one in four patients were not anticoagulated despite raised CHA2DS2-VASc scores. 12-month MACE outcomes did not differ by sex (male: 30.2% vs. female: 29.4%; p = 0.685), though bleeding events were more common in male patients (2.4% vs. 1.3%; p = -0.038), driven by minor bleeding (1.2% vs. 0.5%).

Conclusion: In this large AF cohort from India, male patients had a higher prevalence of ischaemic heart disease, smoking, and alcohol use, while female patients had a higher prevalence of valvular heart disease. MACE did not differ by sex, though bleeding was more common in males. Almost a quarter of patients were not anticoagulated despite raised thromboembolic risk.

Keywords: India; Kerala; South Asia; atrial fibrillation; sex differences.

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Conflict of interest statement

GYHL reports: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi‐Sankyo, Anthos. No fees are received personally. GYHL is a National Institute for Health and Care Research (NIHR) Senior Investigator and co‐principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 899871. DG reports: Speaker for Boehringer Ingelheim, Biosense Webster, and Boston Scientific. Proctor for Abbott. Research Grants from Medtronic, Biosense Webster and Boston Scientific. The other authors report no conflicts of interest.

References

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