Highlights
- •Female sex has been an embolic risk factor, with 1 point on CHA2DS2-VASc score.
- •However, female sex as risk factor has not been strongly confirmed in literature.
- •In FANTASIIA Registry, women were older with high comorbidity status and risk scores.
- •Women had less major cardiovascular events and mortality at long term follow-up.
- •Female sex had independent protective effect against adverse events.
Abstract
Background
While many risk factors for Atrial Fibrillation (AF) have been identified, there are
important differences in their relative impact between sexes. The aim of our study
was to investigate the influence of sex as a long-term predictor of adverse events
in “real world” AF patients treated with direct oral anticoagulants.
Methods
The FANTASIIA registry is a prospective, national and multicentric study including
outpatients with anticoagulated AF patients. Baseline characteristics and adverse
events at 3 years of follow-up were collected and classified by sex. Cox multivariate
analysis was performed to investigate the role of sex in major events and composite
outcomes.
Results
A total of 1956 patients were included in the study. 43.9% of them were women, with
a mean age of 73.8 ± 9.4 years (women were older 76.5 ± 7.9 vs 71.7 ± 10.1, p<0.001). Women had higher rate of cardiovascular risk factors and higher mean of CHA2DS2-VASc (4.4 ± 1.4 vs 3.7 ± 1.6, p<0.001) and HAS-BLED (2.1 ± 1.0 vs 1.9 ± 1.1, p<0.001) than men. After 3 years of follow-up, rates of major events were similar in
both groups with limit difference for all-cause mortality (4.4%/year in women vs 5.6%/year
in men; p = 0.056). However, all the composite events were more frequent in women. We observed
in the non-adjusted adverse events lower rate of all-cause mortality (HR 0.62, 95%CI
0.47–0.81; p<0.001), composite 1 outcomes (HR 0.80, 95%CI 0.65–0.98; p = 0.029) and composite 2 (HR 0.77, 95%CI 0.64–0.94; p = 0.010) in women compared with men. In multivariate Cox regression analysis observed
that female sex was an independently protector factor for all-cause mortality and
for the composite outcomes 1 and 2.
Conclusions
In this “real world” study of anticoagulated AF patients, women could have a protective
role against development of adverse events, mainly on all-cause mortality and combined
events.
Keywords
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Article info
Publication history
Published online: April 14, 2020
Accepted:
April 3,
2020
Received in revised form:
March 27,
2020
Received:
February 29,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
