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Europace. 2015 Jan;17(1):24-31. doi: 10.1093/europace/euu155. Epub 2014 Jun 22.

Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation.

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University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
EORP Department, European Society of Cardiology, Sophia Antipolis, France.
Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Department of Cardiology, Colentina University Hospital, Stefan cel Mare 19-21, Sector 2, Bucharest, Romania.
Cardiovascular Department, S. Filippo Neri Hospital Rome, Rome, Italy.
Department of Cardiology, Silesian Center for Heart Disease, ul. M Curie-Sklodowskiej 9, 41-800 Zabrze, Poland.
Department of Cardiology, Aalborg University Hospital and Aalborg Thrombosis Research Unit, DK-9000 Aalborg, Denmark Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Sondre Skovvej 15, DK-9000 Aalborg, Denmark.
Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Oradea, Romania.
Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.



Sex differences in the epidemiology and clinical management of AF are evident. Of note, females are more symptomatic and if age >65, are at higher risk of thromboembolism if incident AF develops, compared with males.


In an analysis from the dataset of the Euro Observational Research Programme on Atrial Fibrillation (EORP-AF) Pilot survey (n = 3119), we examined sex-related differences in presentation, treatment, and outcome of contemporary patients with AF in Europe.Female subjects were older (P < 0.0001), with a greater proportion aged ≥75 years, with more heart failure and hypertension. Heart failure with preserved ejection fraction was more common in females (P < 0.0001), as was valvular heart disease (P = 0.0003). Females were more symptomatic compared with males with a higher proportion being EHRA Class III and IV (P = 0.0012). The more common symptoms that were more prevalent in females were palpitations (P < 0.0001) and fear/anxiety (P = 0.0007). Other symptoms (e.g. dyspnoea, chest pain, fatigue, etc.) were not different between males and females. Health status scores were significantly lower for females overall, specifically for the psychological and physical domains (both P < 0.0001) but not for the sexual activity domain (P = 0.9023). Females were less likely to have electrical cardioversion (18.9 vs. 25.5%, P < 0.0001), and more likely to receive rate control (P = 0.002). Among patients recruited in hospital and discharged alive (n = 2009), documented contraindications to vitamin K antagonist (VKA) were evident in 23.8% of females. A CHA2DS2-VASc score ≥2 was found in 94.7% of females and 74.6% of males (P < 0.0001), with oral anticoagulants being used in 95.3 and 76.2%, respectively (P < 0.0001). A HAS-BLED score of ≥3 was found in 12.2% of females and 14.5% of males. Independent predictors of VKA use in females on multivariate analysis were CHA2DS2-VASc score (P = 0.0007), lower HAS-BLED score (P = 0.0284), and prosthetic mechanical valves (P = 0.0276).


The EORP-AF Pilot survey provides contemporary data on sex differences in clinical features and management of AF patients participating in the EORP-AF Pilot registry. Female subjects were older and more symptomatic, compared with males, and were more likely to receive rate control. Also, female patients were at higher stroke risk overall, but oral anticoagulation was used in a high proportion of patients.


Anticoagulation; Atrial fibrillation; Female; Survey

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