Korean Circ J.  2018 Jun;48(6):519-528. 10.4070/kcj.2017.0389.

Gender-related Differences in Management of Nonvalvular Atrial Fibrillation in an Asian Population

• Lee JM
• Kim TH
• Cha MJ
• Park J
• Park JK
• Kang KW
• Shim J
• Uhm JS
• Kim J
• Park HW
• Lee YS
• Choi EK
• Kim CS
• Joung B
• Kim JB

• KMID: 2412545
• DOI: http://doi.org/10.4070/kcj.2017.0389

Abstract

BACKGROUND AND OBJECTIVES
Gender-related differences in health care utilization for atrial fibrillation (AF) are increasingly recognized. However, large cohort data for examining gender-related differences in AF are lacking in Asian populations.
METHODS
The Registry for Comparison Study of Drugs for Symptom Control and Complication Prevention of AF (CODE-AF Registry) is a prospective observational cohort-study that enrolled participants at 10 tertiary hospitals in South Korea. Baseline characteristics retrieved from the CODE-AF Registry were analyzed.
RESULTS
A total of 6,274 patients were recruited (mean age 67±11 years, mean CHA2DS2-VASc score 2.7±1.7, 63% male, 65% paroxysmal AF) from June 2016 to April 2017. Women underwent less electric cardioversion (12.3% vs. 19.6%, p < 0.001), less radiofrequency ablation (12.4% vs. 17.9%, p < 0.001), and less antiarrhythmic drug therapy (44.7% vs. 49.5%, p < 0.001), despite having more severe symptoms (symptom class III or IV, 45.8% vs. 37.5%, p < 0.001). Among patients with a CHA2DS2-VA score of 2 or more, a slightly higher proportion of women were taking oral anticoagulants than men (85.7% vs. 81.9%, p=0.002), and non-vitamin K antagonist oral anticoagulant (NOAC) use was more prevalent in women than men (70.4% vs. 62.3%, p < 0.001). Insufficient NOAC dosing was very common, more so in women than men (61.5% vs. 56.3%, p < 0.001).
CONCLUSIONS
Female patients with AF were treated more conservatively and rhythm control strategies were used less frequently than in males, even though the female patients with AF had more severe symptoms. While insufficient NOAC dosing was common in both sex, it was significantly more frequent in women.

Keyword

Atrial fibrillation; Registries; Sex characteristics; Asian ceancestry group; Anticoagulants

MeSH Terms

Anticoagulants
Asian Continental Ancestry Group*
Atrial Fibrillation*
Catheter Ablation
Cohort Studies
Drug Therapy
Electric Countershock
Female
Humans
Korea
Male
Patient Acceptance of Health Care
Prospective Studies
Registries
Sex Characteristics
Tertiary Care Centers
Anticoagulants

Figure

• 

  Figure 1 Proportions of anticoagulation use in men and women according to stroke risk scores (Low stroke-risk group=CHA2DS2-VA score of 1, intermediate to high stroke-risk group= CHA2DS2-VA score of 2 or more).NOAC = non-vitamin K antagonist oral anticoagulant.*p<0.01; †p<0.001.

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