Gender and contemporary risk of adverse events in atrial fibrillation.

Autor:	Champsi A; Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.; West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.; NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Queen Elizabeth Hospital, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK., Mobley AR; Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.; West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.; NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Queen Elizabeth Hospital, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK., Subramanian A; Institute of Applied Health Research, University of Birmingham, University Road West, Birmingham B15 2TT, UK., Nirantharakumar K; West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.; NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Queen Elizabeth Hospital, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK.; Institute of Applied Health Research, University of Birmingham, University Road West, Birmingham B15 2TT, UK., Wang X; Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.; NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Queen Elizabeth Hospital, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK., Shukla D; West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.; Institute of Applied Health Research, University of Birmingham, University Road West, Birmingham B15 2TT, UK., Bunting KV; Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.; NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Queen Elizabeth Hospital, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK., Molgaard I; Patient & Public Representatives, European Society of Cardiology, Sophia Antipolis, France., Dwight J; Patient & Public Representatives, European Society of Cardiology, Sophia Antipolis, France., Arroyo RC; Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium., Crijns HJGM; Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.; Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands., Guasti L; Department of Medicine and Surgery, University of Insubria, Varese, Italy., Lettino M; Cardiothoracic and Vascular Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy., Lumbers RT; Institute of Health Informatics, University College London, London, UK.; NIHR University College London Hospitals Biomedical Research Centre, London, UK., Maesen B; Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.; Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands., Rienstra M; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands., Svennberg E; Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden., Țica O; Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.; Cardiology Department, Emergency County Clinical Hospital of Oradea, Oradea, Romania., Traykov V; Clinic of Cardiology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria., Tzeis S; Cardiology Department, Mitera Hospital, Athens, Greece., van Gelder I; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands., Kotecha D; Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.; West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.; NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, Queen Elizabeth Hospital, Heritage Building, Mindelsohn Way, Birmingham B15 2TH, UK.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Sep 29; Vol. 45 (36), pp. 3707-3717.
DOI:	10.1093/eurheartj/ehae539
Abstrakt:	Background and Aims: The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial. Methods: The population cohort study used electronic healthcare records of 16 587 749 patients from UK primary care (2005-2020). Primary (composite of all-cause mortality, ischaemic stroke, or arterial thromboembolism) and secondary outcomes were analysed using Cox hazard ratios (HR), adjusted for age, socioeconomic status, and comorbidities. Results: 78 852 patients were included with AF, aged 40-75 years, no prior stroke, and no prescription of oral anticoagulants. 28 590 (36.3%) were women, and 50 262 (63.7%) men. Median age was 65.7 years (interquartile range 58.5-70.9), with women being older and having other differences in comorbidities. During a total follow-up of 431 086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs. men (95% confidence interval [CI] 0.87-0.92; P < .001) and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83-0.91; P < .001). This was driven by lower mortality in women (HR 0.86, 95% CI 0.83-0.89; P < .001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 95% CI 0.94-1.07; P = .87), any stroke or any thromboembolism (adjusted HR 1.02, 95% CI 0.96-1.07; P = .58), and incident vascular dementia (adjusted HR 1.13, 95% CI 0.97-1.32; P = .11). Clinical risk scores were only modest predictors of outcomes, with CHA2DS2-VA (ignoring gender) superior to CHA2DS2-VASc for primary outcomes in this population (receiver operating characteristic curve area 0.651 vs. 0.639; P < .001) and no interaction with gender (P = .45). Conclusions: Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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