Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database.
Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database.
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DOI：
10.1186/s12872-021-02419-2
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发表时间：
2021-12-16
影响因子：
2.1
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Subramanya V;Claxton JS;Lutsey PL;MacLehose RF;Chen LY;Chamberlain AM;Norby FL;Alonso A
与男性相比，女性房颤（AF）患者的心脏病程度更高，生活质量更差，卒中风险更高，但接受心律控制治疗的可能性更低。这些差异是否存在于老年房颤患者中，以及性别是否改变了节律与频率控制治疗的有效性尚未进行评估。 我们研究了2007年至2015年MarketScan Medicare数据库中年龄≥ 75岁的135，850名男性和139，767名女性被诊断为AF。抗凝剂使用定义为使用华法林或直接口服抗凝剂。心率控制定义为使用心率控制药物或房室结消融。心律控制定义为使用抗心律失常药物、导管消融或心脏复律。我们使用多变量Poisson和考克斯回归模型来估计性别与治疗策略的相关性，并确定治疗策略与不良结局（出血、心力衰竭和卒中）的相关性是否因性别而异。在房颤时，女性平均（SD）为83.8（5.6）岁，男性为82.5（5.2）岁。与男性相比，女性不太可能接受抗凝剂或心律控制治疗。节律控制（与心率相比）与心力衰竭风险更高相关，女性相关性更强（HR女性= 1.41，95%CI 1.34-1.49; HR男性= 1.21，95%CI 1.15-1.28，相互作用p < 0.0001）。在治疗策略与出血或中风风险的关系方面，没有观察到性别差异。75岁及以上患者的房颤治疗存在性别差异。女性不太可能接受抗凝剂和心律控制治疗。与男性相比，女性在接受房颤节律控制策略治疗时发生心力衰竭的风险也更大。需要努力加强女性房颤治疗的使用。未来的研究将需要深入研究这些差异背后的机制。在线版本包含补充材料，可通过10.1186/s12872-021-02419-2获得。
Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. We studied 135,850 men and 139,767 women aged ≥ 75 years diagnosed with AF in the MarketScan Medicare database between 2007 and 2015. Anticoagulant use was defined as use of warfarin or a direct oral anticoagulant. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmic medication, catheter ablation or cardioversion. We used multivariable Poisson and Cox regression models to estimate the association of sex with treatment strategy and to determine whether the association of treatment strategy with adverse outcomes (bleeding, heart failure and stroke) differed by sex. At the time of AF, women were on average (SD) 83.8 (5.6) years old and men 82.5 (5.2) years, respectively. Compared to men, women were less likely to receive an anticoagulant or rhythm control treatment. Rhythm control (vs. rate) was associated with a greater risk for heart failure with a significantly stronger association in women (HR women = 1.41, 95% CI 1.34–1.49; HR men = 1.21, 95% CI 1.15–1.28, p < 0.0001 for interaction). No sex differences were observed for the association of treatment strategy with the risk of bleeding or stroke. Sex differences exist in the treatment of AF among patients aged 75 years and older. Women are less likely to receive an anticoagulant and rhythm control treatment. Women were also at a greater risk of experiencing heart failure as compared to men, when treated with rhythm control strategies for AF. Efforts are needed to enhance use AF therapies among women. Future studies will need to delve into the mechanisms underlying these differences. The online version contains supplementary material available at 10.1186/s12872-021-02419-2.
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影响因子：
5.5
作者：
Bhave PD;Lu X;Girotra S;Kamel H;Vaughan Sarrazin MS
通讯作者：
Vaughan Sarrazin MS
影响因子：
24
作者：
Law, Sharon W. Y.;Lau, Wallis C. Y.;Chan, Esther W.
通讯作者：
Chan, Esther W.
影响因子：
37.8
作者：
Corley, SD;Epstein, AE;Wyse, DG
通讯作者：
Wyse, DG
中国房颤患者在表现、生活质量和治疗方面的性别差异：来自中国房颤登记研究的见解
影响因子：
3.1
作者：
Li, Yan-Ming;Jiang, Chao;Ma, Chang-Sheng
通讯作者：
Ma, Chang-Sheng
影响因子：
2.6
作者：
Andrade, Susan E.;Harrold, Leslie R.;Tjia, Jennifer;Cutrona, Sarah L.;Saczynski, Jane S.;Dodd, Katherine S.;Goldberg, Robert J.;Gurwitz, Jerry H.
通讯作者：
Gurwitz, Jerry H.