Sex differences in clinical features, utilization of oral anticoagulant agents, and one-year outcome in Middle Eastern patients with atrial fibrillation.

OBJECTIVE: Studies have revealed that sex can predict differences in multiple aspects of atrial fibrillation (AF). These differences are underreported in the Middle East. This study aims to describe sex-specific differences in risk factors, symptomatology, management, and outcomes in Middle Eastern patients with AF.

METHODS: The JoFib (Jordan-Atrial-Fibrillation) study is an observational, prospective, multicenter, nationwide registry in AF. Comparisons were made between female and male patients using Pearson chi-square and Mann-Whitney U tests. Multivariable regression models were constructed to investigate whether the female sex was predictive of any AF-related outcomes (all-cause death, cardiovascular death, ischemic stroke or systemic embolism [IS/SE], major bleeding, and clinically relevant non-major bleeding).

RESULTS: Of 2,020 patients with AF, 54% (n = 1091) were females. Females with AF were older (median age 71 vs. 69, p < 0.001), but had less heart failure (20.9% vs. 27.2%, p = 0.001) and coronary artery disease (7.5% vs. 14.7%, p < 0.001). Females with AF were more symptomatic (74.7% vs. 66.5%, p < 0.001) and frequently received anticoagulant therapy (84.4% vs. 78.9%, p = 0.001). Rhythm control was pursued less frequently in females (23.4% vs. 27.3%, p = 0.04). All studied outcomes occurred with similar frequencies in females and males, and sex was not significantly predictive of any outcome.

CONCLUSION: Females with AF are more symptomatic, yet they are treated less with rhythm control. Despite higher risk, females have similar risk-adjusted all-cause cardiovascular death and stroke rates compared to males. Future studies should explore how treatments and interventions can influence quality of life and cardiovascular outcomes in females with AF.