Symptoms and care of irregular heartbeats differ by sex

The finding adds to a growing body of research that highlights male-female disparities in how cardiovascular disease is managed, and serves as a caution to doctors to be alert to treatment decisions that might perpetuate the differences.

"We need to pay close attention to women with atrial fibrillation, and it's important for physicians to know that women with the condition have more symptoms and a lower quality of life than their male counterparts," said Jonathan P. Piccini, M.D., MHSc, an assistant professor of medicine and electrophysiology at Duke. Piccini presented the data March 10, 2013, during the American College of Cardiology's 62nd Annual Scientific Sessions & Expo.

Atrial fibrillation is the most common form of abnormal heart rhythm, affecting more than 2 million people in the United States. Symptoms include heart palpitations, shortness of breath and fatigue. The condition is associated with an increased risk of stroke and reduced survival.

Piccini and colleagues at Duke analyzed outcomes data from more than 10,000 patients with atrial fibrillation enrolled in a long-term, observational study called the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, or ORBIT-AF.

The study was launched in 2010 to help healthcare providers understand how atrial fibrillation is managed and to better understand long-term outcomes among patients in "real-world" situations. The registry is tool to evaluate long-term health outcomes, quality of life, and the impact of existing and emerging treatments.

The current analysis involved 10,132 people with atrial fibrillation from 176 clinics and practices across the country. About 42 percent of study participants were women.

Both men and women took blood thinners at about the same rate, but beyond that, several disparities emerged. Compared to men, women in the study:

• Tended to be older;
• Generally had lower rates of coronary artery disease and sleep apnea, as well as a less severe form of atrial fibrillation that occurs periodically;
• Had higher risk for stroke;
• Reported lower quality of life on a survey that measures symptoms, daily activities and treatment concerns in patients with atrial fibrillation;
• Had less optimal control of their anticoagulation.

"If you look at many disease processes, the experience and outcomes of men and women are different," Piccini said. "Although women live longer than men in general, in many cardiovascular diseases, women have more functional limitations. Why this occurs is the $64,000 question."

Despite having more symptoms and worse quality of life, women with atrial fibrillation tended to live longer than their male peers. Piccini said additional studies could help pinpoint the causes of the disparities.

In addition to Piccini, study authors include Sunghee Kim, Benjamin A. Steinberg, DaJuanicia N Holmes, Jack Ansell, Gregg C Fonarow, Bernard J Gersh, Alan S. Go, Elain Hylek, Peter R Kowey, Kenneth W. Mahaffey, Laine Thomas, Paul Chang and Eric D Peterson.

Janssen Scientific Affairs, LLC, provided funding for the study.