Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial
Abstract
:1. Introduction
2. Material and Methods
2.1. Inclusion Criteria
- − Men and women aged ≥ 18 years.
- − An electrocardiographic or external or implantable Holter monitoring diagnosis of AF with a duration of over 30 s.
- − A registered AF episode in the last year.
- − Possible sinus rhythm at the time of inclusion.
2.2. Exclusion Criteria
- − Patients in which long-term follow-up is not contemplated or not possible.
- − Patients with secondary transient AF due to reversible causes.
- − Patients enrolled in interventional studies conditioning treatments, frequency of consultation or diagnostic procedures.
2.3. Ethical Statement
2.4. Participating Hospitals
2.4.1. Conduct of the Study
2.4.2. Data Registry
2.4.3. Quality Assurance and Control
2.5. Statistical Analysis
3. Results
3.1. Basal Characteristics
Cardiovascular Risk Factors (CVRFs)
3.2. Complementary Tests
3.3. Cardiovascular History
3.4. Personal History, Comorbidities and Previous Thromboembolic Events and Bleeding Episodes
3.5. Risk Scales
3.6. Characteristics of Atrial Fibrillation
3.7. Previous Treatment Strategy (in Non-First Diagnosis of AF)
3.8. Current Treatment Strategy
3.9. Anticoagulation
3.10. EQ-5D and ACTS Questionnaires
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Women RhC | Men RhC | Women RC | Men RC | p-Value | |
Age | n | 182 | 454 | 144 | 227 | <0.001 |
mean ± SD | 67.94 ± 8.96 | 60.98 ± 10.91 | 76.44 ± 8.57 | 75.22 ± 9.68 | ||
Body mass index | n | 181 | 452 | 144 | 227 | 0.955 |
mean ± SD | 29.92 ± 5.27 | 29.73 ± 4.74 | 29.18 ± 5.83 | 29.44 ± 4.79 | ||
Diameter of LA (mm) | n | 87 | 233 | 80 | 124 | 0.002 |
mean ± SD | 42.07 ± 8.92 | 44.86 ± 10.8 | 43.44 ± 12.77 | 43.93 ± 14.07 | ||
Volume of LA (ml/m2) | n | 33 | 87 | 30 | 55 | 0.054 |
mean ± SD | 42.51 ± 19.96 | 55.3 ± 34.86 | 65.98 ± 38.42 | 62.47 ± 30.44 | ||
LVEF (%) | n | 117 | 281 | 102 | 167 | 0.002 |
mean ± SD | 59.32 ± 10.71 | 55.26 ± 12.4 | 58.75 ± 11.19 | 53.5 ± 14.64 | ||
HF based on NYHA functional class (n) | 17 | 64 | 29 | 40 | 0.009 | |
I | 0.00% | 28.13% | 17.24% | 10.00% | ||
II | 58.82% | 54.69% | 58.62% | 50.00% | ||
III | 41.18% | 17.19% | 20.69% | 40.00% | ||
IV | 0.00% | 0.00% | 3.45% | 0.00% | ||
CHA2DS2-VASc scale | n | 182 | 454 | 144 | 227 | <0.001 |
mean ± SD | 2.62 ± 1.32 | 1.52 ± 1.32 | 3.64 ± 1.22 | 3 ± 1.35 | ||
HTN | n | 182 | 454 | 144 | 227 | 0.101 |
% | 61.54 | 54.41 | 72.92 | 71.81 | ||
COPD | n | 182 | 454 | 144 | 227 | 0.058 |
% | 3.85 | 8.15 | 9.72 | 22.03 | ||
Paroxysmal AF | n | 182 | 454 | 144 | 227 | 0.009 |
% | 39.01 | 28.41 | 7.64 | 5.29 | ||
EHRA classification (n) | 182 | 454 | 144 | 227 | 0.027 | |
I | 22.53% | 33.70% | 35.42% | 41.85% | ||
II a | 46.70% | 42.07% | 32.64% | 30.40% | ||
II b | 20.33% | 16.52% | 18.75% | 14.98% | ||
III | 10.44% | 6.83% | 12.50% | 11.89% | ||
IV | 0.00% | 0.88% | 0.69% | 0.88% |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Complementary tests | |||||||
Creatinine (mg/dL) | 956 | 0.99 ± 0.36 | 646 | 1.04 ± 0.35 | 310 | 0.88 ± 0.34 | <0.001 |
LVEF (%) | 667 | 56.06 ± 12.73 | 448 | 54.6 ± 13.29 | 219 | 59.05 ± 10.91 | <0.001 |
Diameter of LA (mm) | 524 | 43.96 ± 11.7 | 357 | 44.54 ± 12.02 | 167 | 42.73 ± 10.92 | 0.011 |
Volume of LA (mL/m2) | 205 | 56.73 ± 32.94 | 142 | 58.07 ± 33.29 | 63 | 53.68 ± 32.18 | 0.212 |
Bundle block | 90 | 8.94% | 71 | 10.43% | 19 | 5.83% | 0.017 |
LBB | 38/90 | 42.22% | 27/71 | 38.03% | 11/19 | 57.89% | 0.190 |
RBB | 51/90 | 56.67% | 44/71 | 61.97% | 7/19 | 36.84% | 0.068 |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Cardiovascular history | |||||||
Type of device | 100 | 72 | 28 | 0.068 | |||
Pacemaker carrier | 76 | 76.00% | 51 | 70.83% | 25 | 89.29 | |
ICD carrier | 24 | 24.00% | 21 | 29.17% | 3 | 10.71 | |
Heart failure | 150 | 14.90% | 104 | 15.27% | 46 | 14.11 | 0.628 |
HF based on NYHA functional class | 150 | 104 | 46 | 0.213 | |||
I | 27 | 18.00% | 22 | 21.15% | 5 | 10.87% | |
II | 82 | 54.67% | 55 | 52.88% | 27 | 58.70% | |
III | 40 | 26.67% | 27 | 25.96% | 13 | 28.26% | |
IV | 1 | 0.67% | 0 | 0.00% | 1 | 2.17% | |
NYHA functional class ≥ II | 123/150 | 82.00% | 82/104 | 78.85% | 41/46 | 89.13% | 0.168 |
Coronary disease (ischemic heart disease) | 116 | 11.52% | 91 | 13.36% | 25 | 7.67% | 0.008 |
Valve disease | 117 | 11.62% | 69 | 10.13% | 48 | 14.72% | 0.033 |
Cardiomyopathy | 78 | 7.75% | 64 | 9.40% | 14 | 4.29% | 0.005 |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Personal history-concomitant diseases | |||||||
COPD | 108 | 10.72% | 87 | 12.78% | 21 | 6.44% | 0.002 |
Neoplasms | 83 | 8.24% | 56 | 8.22% | 27 | 8.28% | 0.975 |
Hyperthyroidism | 19 | 1.89% | 15 | 2.20% | 4 | 1.23% | 0.334 |
Hypothyroidism | 66 | 6.55% | 27 | 3.96% | 39 | 11.96% | <0.001 |
Previous thromboembolic and bleeding events | |||||||
Thromboembolic events | 61 | 6.06% | 42 | 6.17% | 19 | 5.83% | 0.833 |
Ischemic stroke | 29 | 2.88% | 19 | 2.79% | 10 | 3.07% | 0.805 |
Bleeding events | 36 | 3.57% | 23 | 3.38% | 13 | 3.99% | 0.625 |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Thromboembolic/bleeding risk | |||||||
CHA2DS2-VASc scale | 1007 | 2.35 ± 1.54 | 681 | 2.01 ± 1.5 | 326 | 3.07 ± 1.37 | <0.001 |
HAS-BLED scale | 1007 | 0.7 ± 0.78 | 681 | 0.64 ± 0.78 | 326 | 0.83 ± 0.78 | <0.001 |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Characteristics of atrial fibrillation | |||||||
EHRA classification | 0.052 | ||||||
I | 340 | 33.76% | 248 | 36.42% | 92 | 28.22% | |
IIa | 392 | 38.93% | 260 | 38.18% | 132 | 40.49% | |
IIb | 173 | 17.18% | 109 | 16.01% | 64 | 19.63% | |
III | 95 | 9.43% | 58 | 8.52% | 37 | 11.35% | |
IV | 7 | 0.70% | 6 | 0.88% | 1 | 0.31% | |
Clinical type of AF | 0.009 | ||||||
First diagnosis | 231 | 22.94% | 160 | 23.49 | 71 | 21.78% | |
Paroxysmal | 223 | 22.14% | 141 | 20.70 | 82 | 25.15% | |
Persistent | 265 | 26.32% | 200 | 29.37% | 65 | 19.94% | |
Long duration persistent | 26 | 2.58% | 15 | 2.20% | 11 | 3.37% | |
Permanent | 262 | 26.02% | 165 | 24.23% | 97 | 29.75% | |
Previous strategy (if not first diagnosis of AF) | |||||||
Rhythm control | 403/627 | 64.27% | 274/407 | 67.32% | 129/220 | 58.64% | 0.030 |
Electrical cardioversion | 403 | 274 | 129 | 0.171 | |||
No | 176 | 43.67% | 112 | 40.88% | 64 | 49.61% | |
1 | 143 | 35.48% | 99 | 36.13% | 44 | 34.11% | |
>1 | 84 | 20.84% | 63 | 22.99% | 21 | 16.28% | |
Electrical cardioversion (yes/no) | 227/403 | 56.33% | 162/274 | 59.12% | 65/129 | 50.39% | 0.099 |
Ablation of AF | 403 | 274 | 129 | 0.089 | |||
No | 324 | 80.40% | 215 | 78.47% | 109 | 84.5% | |
Isolation of pulmonary veins | 76 | 18.86% | 58 | 21.17% | 18 | 13.95% | |
AV node ablation | 3 | 0.74% | 1 | 0.36% | 2 | 1.55% |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Current treatment of atrial fibrillation | |||||||
Rhythm control strategy | 636 | 63.16% | 454 | 66.67% | 182 | 55.83% | 0.001 |
Catheter ablation | 168 | 16.68% | 115 | 16.89% | 53 | 16.26% | 0.802 |
Number of interventions | 168 | 1.14 ± 0.38 | 115 | 1.15 ± 0.38 | 53 | 1.11 ± 0.38 | 0.435 |
Electrical cardioversion | 246 | 24.43% | 186 | 27.31% | 60 | 18.4% | 0.002 |
Number of interventions | 246 | 1.32 ± 0.76 | 186 | 1.36 ± 0.83 | 60 | 1.18 ± 0.47 | 0.227 |
Implantation of devices | 38 | 3.77% | 22 | 3.23% | 16 | 4.91% | 0.191 |
Rate control interventions AV node ablation | 9 | 0.89% | 2 | 0.29% | 7 | 2.15% | 0.007 |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
Medication | |||||||
Antiarrhythmic treatment | 390 | 38.73% | 288 | 42.29% | 102 | 31.29% | 0.001 |
Group I and/or III antiarrhythmic drugs | 389/390 | 99.74% | 287/288 | 99.65% | 102/102 | 100.00% | 1.000 |
Type of group I and/or III antiarrhythmic drugs | 389 | 287 | 102 | 0.321 | |||
Amiodarone | 182 | 46.79% | 129 | 44.95% | 53 | 51.96% | |
Dronedarone | 6 | 1.54% | 3 | 1.05% | 3 | 2.94% | |
Sotalol | 13 | 3.34% | 9 | 3.14% | 4 | 3.92% | |
Flecainide | 183 | 47.04% | 142 | 49.48% | 41 | 40.20% | |
Propafenone | 5 | 1.29% | 4 | 1.39% | 1 | 0.98% | |
Beta-blockers | 689 | 68.42% | 464 | 68.14% | 225 | 69.02% | 0.778 |
Non-dihydropyridinic calcium antagonists | 54 | 5.36% | 37 | 5.43% | 17 | 5.21% | 0.886 |
Digoxin | 62 | 6.16% | 37 | 5.43% | 25 | 7.67% | 0.167 |
ACEIs/ARAs | 517 | 51.34% | 350 | 51.40% | 167 | 51.23% | 0.960 |
Diuretics | 346 | 34.36% | 214 | 31.42% | 132 | 40.49% | 0.005 |
Statins | 466 | 46.28% | 317 | 46.55% | 149 | 45.71% | 0.802 |
Antiplatelet medication | 43 | 4.27% | 33 | 4.85% | 10 | 3.07% | 0.192 |
Anticoagulation + antiplatelet drugs | 27 | 2.68% | 21 | 3.08% | 6 | 1.84% | 0.302 |
Anticoagulation | 904 | 89.77% | 597 | 87.67% | 307 | 94.17% | 0.001 |
Type of anticoagulant | 904 | 597 | 307 | 0.020 | |||
Vitamin K antagonist | 532 | 58.85% | 335 | 56.11% | 197 | 64.17% | |
DOACs | 372 | 41.15% | 262 | 43.89% | 110 | 35.83% | |
Type of DOAC | 372 | 262 | 110 | 0.249 | |||
Dabigatran | 128 | 34.41% | 91 | 34.73% | 37 | 33.64% | |
Edoxaban | 50 | 13.44% | 35 | 13.36% | 15 | 13.64% | |
Rivaroxaban | 105 | 28.23% | 80 | 30.53% | 25 | 22.73% | |
Apixaban | 89 | 23.92% | 56 | 21.37% | 33 | 30.00% |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
n | n | n | |||||
Patients | 1007 | 681 | 67.63 | 326 | 32.37 | ||
Age | 1007 | 67.66 ± 11.98 | 681 | 65.73 ± 12.47 | 326 | 71.69 ± 9.74 | <0.001 |
Body Mass Index (BMI) | 1004 | 29.62 ± 5.02 | 679 | 29.63 ± 4.75 | 325 | 29.59 ± 5.53 | 0.405 |
Cardiovascular Risk Factors | |||||||
Tobacco | <0.001 | ||||||
Newer | 658 | 65.34% | 369 | 54.19% | 289 | 88.65 | |
Current smoker | 86 | 8.54% | 75 | 11.01% | 11 | 3.37% | |
Recent ex-smoker (< 6 months) | 19 | 1.89% | 19 | 2.79% | 0 | 0.00% | |
Former smoker (≥ 6 months) | 244 | 24.23% | 218 | 32.01% | 26 | 7.98% | |
Smokes (yes) | 86 | 8.54% | 75 | 11.01% | 11 | 3.37% | <0.001 |
Alcohol | <0.001 | ||||||
No | 419 | 41.61% | 182 | 26.73% | 237 | 72.70% | |
Light | 495 | 49.16% | 408 | 59.91% | 87 | 26.69% | |
Moderate | 76 | 7.55% | 74 | 10.87% | 2 | 0.61% | |
High | 17 | 1.69% | 17 | 2.50% | 0 | 0.00% | |
Drink alcohol (yes) | 588 | 58.39% | 499 | 73.27% | 89 | 27.30% | <0.001 |
Hypertension | 627 | 62.26% | 410 | 60.21% | 217 | 66.56% | 0.051 |
Diabetes mellitus | 0.203 | ||||||
No | 818 | 81.23% | 543 | 79.74% | 275 | 84.36% | |
Type 1 | 6 | 0.60% | 5 | 0.73% | 1 | 0.31% | |
Type 2 | 183 | 18.17% | 133 | 19.53% | 50 | 15.34% | |
Diabetes mellitus (yes) | 189 | 18.77% | 138 | 20.26% | 51 | 15.64% | 0.079 |
Dyslipidemia | 487 | 48.36% | 333 | 48.90% | 154 | 47.24% | 0.622 |
Variables | All | Men | Women | p-Value | |||
---|---|---|---|---|---|---|---|
EQ-5D questionnaire | 941 | 93.45 | 639 | 93.83 | 302 | 92.64 | 0.474 |
Mobility | 941 | 639 | 302 | <0.001 | |||
I have no problems walking | 648 | 68.86% | 489 | 76.53% | 159 | 52.65% | |
I have some problemswalking | 288 | 30.61% | 149 | 23.32% | 139 | 46.03% | |
I have to stay in bed | 5 | 0.53% | 1 | 0.16% | 4 | 1.32% | |
Personal care | 941 | 639 | 302 | <0.001 | |||
I have no problems with personal care | 862 | 91.60% | 599 | 93.74% | 263 | 87.09% | |
I have some problems washing or dressing | 73 | 7.76% | 39 | 6.1% | 34 | 11.26% | |
I am unable to wash or dress myself | 6 | 0.64% | 1 | 0.16% | 5 | 1.66% | |
Daily life activities | 941 | 639 | 302 | <0.001 | |||
I have no problems performing daily life activities | 722 | 76.73% | 520 | 81.38% | 202 | 66.89% | |
I have some problems performing daily life activities | 202 | 21.47% | 114 | 17.84% | 88 | 29.14% | |
I am unable to perform daily life activities | 17 | 1.81% | 5 | 0.78% | 12 | 3.97% | |
Pain/discomfort | 941 | 639 | 302 | <0.001 | |||
I have no pain or discomfort | 652 | 69.29% | 485 | 75.9% | 167 | 55.3% | |
I have moderate pain or discomfort | 262 | 27.84% | 139 | 21.75% | 123 | 40.73% | |
I have much pain or discomfort | 27 | 2.87% | 15 | 2.35% | 12 | 3.97% | |
Anxiety/depression | 941 | 639 | 302 | <0.001 | |||
I am not anxious or depressed | 655 | 69.61% | 484 | 75.74% | 171 | 56.62% | |
I am moderately anxious or depressed | 254 | 26.99% | 137 | 21.44% | 117 | 38.74% | |
I am very anxious or depressed | 32 | 3.40% | 18 | 2.82% | 14 | 4.64% | |
EQ-5D index (summarizing score) * | 941 | 0.82 ± 0.21 | 639 | 0.85 ± 0.19 | 302 | 0.74 ± 0.22 | <0.001 |
ACTS Questionnaire | |||||||
---|---|---|---|---|---|---|---|
Variables | All | Men | Women | p-Value | |||
Burden scale | 738 | 53.43 ± 7.95 | 493 | 53.98 ± 8.02 | 245 | 52.31 ± 7.71 | < 0.001 |
Benefit scale | 738 | 11.34 ± 2.55 | 493 | 11.38 ± 2.62 | 245 | 11.26 ± 2.42 | 0.389 |
General burden scale | 738 | 1.69 ± 1.01 | 493 | 1.67 ± 1.02 | 245 | 1.74 ± 1 | 0.224 |
General benefit scale | 738 | 3.63 ± 1.01 | 493 | 3.62 ± 1.04 | 245 | 3.65 ± 0.95 | 0.980 |
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Durán-Bobín, O.; Elices-Teja, J.; González-Melchor, L.; Vázquez-Caamaño, M.; Fernández-Obanza, E.; González-Babarro, E.; Cabanas-Grandío, P.; Piñeiro-Portela, M.; Prada-Delgado, O.; Gutiérrez-Feijoo, M.; et al. Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial. J. Clin. Med. 2021, 10, 3846. https://doi.org/10.3390/jcm10173846
Durán-Bobín O, Elices-Teja J, González-Melchor L, Vázquez-Caamaño M, Fernández-Obanza E, González-Babarro E, Cabanas-Grandío P, Piñeiro-Portela M, Prada-Delgado O, Gutiérrez-Feijoo M, et al. Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial. Journal of Clinical Medicine. 2021; 10(17):3846. https://doi.org/10.3390/jcm10173846
Chicago/Turabian StyleDurán-Bobín, Olga, Juliana Elices-Teja, Laila González-Melchor, María Vázquez-Caamaño, Emiliano Fernández-Obanza, Eva González-Babarro, Pilar Cabanas-Grandío, Miriam Piñeiro-Portela, Oscar Prada-Delgado, Mario Gutiérrez-Feijoo, and et al. 2021. "Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial" Journal of Clinical Medicine 10, no. 17: 3846. https://doi.org/10.3390/jcm10173846
APA StyleDurán-Bobín, O., Elices-Teja, J., González-Melchor, L., Vázquez-Caamaño, M., Fernández-Obanza, E., González-Babarro, E., Cabanas-Grandío, P., Piñeiro-Portela, M., Prada-Delgado, O., Gutiérrez-Feijoo, M., Freire, E., Díaz-Castro, O., Muñiz, J., García-Seara, J., & Gonzalez-Juanatey, C. (2021). Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial. Journal of Clinical Medicine, 10(17), 3846. https://doi.org/10.3390/jcm10173846