Gender and contemporary risk of adverse events in atrial fibrillation

Asgher Champsi; Alastair Mobley; Anuradhaa Subramanian; Krishnarajah Nirantharakumar; Xiaoxia Wang; David Shukla; Karina Bunting; Inge Molgaard; Jeremy Dwight; Ruben Casado Arroyo; Harry J G M Crijns; Luigina Guasti; Maddalena Lettino; R Thomas Lumbers; Bart Maesen; Michiel  Rienstra; Emma  Svennberg; Otilia Tica; Vassil Traykov; Stylianos Tzeis; Isabelle van Gelder; Dipak Kotecha

doi:10.1093/eurheartj/ehae539

Gender and contemporary risk of adverse events in atrial fibrillation

Asgher Champsi, Alastair Mobley, Anuradhaa Subramanian, Krishnarajah Nirantharakumar, Xiaoxia Wang, David Shukla, Karina Bunting, Inge Molgaard, Jeremy Dwight, Ruben Casado Arroyo, Harry J G M Crijns, Luigina Guasti, Maddalena Lettino, R Thomas Lumbers, Bart Maesen, Michiel Rienstra, Emma Svennberg, Otilia Tica, Vassil Traykov, Stylianos TzeisIsabelle van Gelder, Dipak Kotecha^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background and Aims: The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial.

Methods: Population cohort study using 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, age 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 other differences in comorbidities. During total follow-up of 431,086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs men (95% CI 0.87-0.92; p<0.001), and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83-0.91; p<0.001). This was driven by lower mortality in women (HR 0.86, 0.83-0.89; p<0.001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 0.94-1.07; p=0.87), any stroke or any thromboembolism (1.02, 0.96-1.07; p=0.58), and incident vascular dementia (1.13, 0.97-1.32; p=0.11). 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 operator curve area 0.651 vs 0.639; p<0.001), and no interaction with gender (p=0.45).

Conclusions: Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation.

Original language	English
Article number	ehae539
Number of pages	11
Journal	European Heart Journal
Volume	45
Issue number	36
Early online date	1 Sept 2024
DOIs	https://doi.org/10.1093/eurheartj/ehae539
Publication status	E-pub ahead of print - 1 Sept 2024

Keywords

Atrial fibrillation
Gender
Women
Sex
Stroke
Thromboembolism

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10.1093/eurheartj/ehae539Licence: Creative Commons: Attribution (CC BY)

ehae539Final published version, 2 MBLicence: Creative Commons: Attribution (CC BY)

Preventing stroke, premature death and cognitive decline in a broader community of patients with atrial fibrillation using healthcare data for pragmatic research (DaRe2THINK)
Kotecha, D. (Principal Investigator), Shukla, D. (Researcher), Calvert, M. (Co-Investigator), Nirantharakumar, K. (Co-Investigator) & Gkoutos, G. (Co-Investigator)
NIHR EVALUATION, TRIALS AND STUDIES COORDINATING CENTRE, CRN: WEST MIDLANDS
1/12/20 → 30/11/25
Project: Other Government Departments

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Champsi, A., Mobley, A., Subramanian, A., Nirantharakumar, K., Wang, X., Shukla, D., Bunting, K., Molgaard, I., Dwight, J., Casado Arroyo, R., Crijns, H. J. G. M., Guasti, L., Lettino, M., Lumbers, R. T., Maesen, B., Rienstra, M., Svennberg, E., Tica, O., Traykov, V., ... Kotecha, D. (2024). Gender and contemporary risk of adverse events in atrial fibrillation. European Heart Journal, 45(36), Article ehae539. Advance online publication. https://doi.org/10.1093/eurheartj/ehae539

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title = "Gender and contemporary risk of adverse events in atrial fibrillation",

abstract = "Background and Aims: The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial.Methods: Population cohort study using 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, age 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 other differences in comorbidities. During total follow-up of 431,086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs men (95% CI 0.87-0.92; p<0.001), and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83-0.91; p<0.001). This was driven by lower mortality in women (HR 0.86, 0.83-0.89; p<0.001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 0.94-1.07; p=0.87), any stroke or any thromboembolism (1.02, 0.96-1.07; p=0.58), and incident vascular dementia (1.13, 0.97-1.32; p=0.11). 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 operator curve area 0.651 vs 0.639; p<0.001), and no interaction with gender (p=0.45).Conclusions: Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation. ",

keywords = "Atrial fibrillation, Gender, Women, Sex, Stroke, Thromboembolism",

author = "Asgher Champsi and Alastair Mobley and Anuradhaa Subramanian and Krishnarajah Nirantharakumar and Xiaoxia Wang and David Shukla and Karina Bunting and Inge Molgaard and Jeremy Dwight and {Casado Arroyo}, Ruben and Crijns, {Harry J G M} and Luigina Guasti and Maddalena Lettino and Lumbers, {R Thomas} and Bart Maesen and Michiel Rienstra and Emma Svennberg and Otilia Tica and Vassil Traykov and Stylianos Tzeis and {van Gelder}, Isabelle and Dipak Kotecha",

year = "2024",

month = sep,

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doi = "10.1093/eurheartj/ehae539",

language = "English",

volume = "45",

journal = "European Heart Journal",

issn = "0195-668X",

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number = "36",

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Champsi, A , Mobley, A , Subramanian, A , Nirantharakumar, K, Wang, X, Shukla, D , Bunting, K, Molgaard, I, Dwight, J, Casado Arroyo, R, Crijns, HJGM, Guasti, L, Lettino, M, Lumbers, RT, Maesen, B, Rienstra, M, Svennberg, E, Tica, O, Traykov, V, Tzeis, S, van Gelder, I & Kotecha, D 2024, 'Gender and contemporary risk of adverse events in atrial fibrillation', European Heart Journal, vol. 45, no. 36, ehae539. https://doi.org/10.1093/eurheartj/ehae539

TY - JOUR

T1 - Gender and contemporary risk of adverse events in atrial fibrillation

AU - Champsi, Asgher

AU - Mobley, Alastair

AU - Subramanian, Anuradhaa

AU - Nirantharakumar, Krishnarajah

AU - Wang, Xiaoxia

AU - Shukla, David

AU - Bunting, Karina

AU - Molgaard, Inge

AU - Dwight, Jeremy

AU - Casado Arroyo, Ruben

AU - Crijns, Harry J G M

AU - Guasti, Luigina

AU - Lettino, Maddalena

AU - Lumbers, R Thomas

AU - Maesen, Bart

AU - Rienstra, Michiel

AU - Svennberg, Emma

AU - Tica, Otilia

AU - Traykov, Vassil

AU - Tzeis, Stylianos

AU - van Gelder, Isabelle

AU - Kotecha, Dipak

PY - 2024/9/1

Y1 - 2024/9/1

N2 - Background and Aims: The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial.Methods: Population cohort study using 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, age 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 other differences in comorbidities. During total follow-up of 431,086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs men (95% CI 0.87-0.92; p<0.001), and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83-0.91; p<0.001). This was driven by lower mortality in women (HR 0.86, 0.83-0.89; p<0.001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 0.94-1.07; p=0.87), any stroke or any thromboembolism (1.02, 0.96-1.07; p=0.58), and incident vascular dementia (1.13, 0.97-1.32; p=0.11). 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 operator curve area 0.651 vs 0.639; p<0.001), and no interaction with gender (p=0.45).Conclusions: Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation.

AB - Background and Aims: The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial.Methods: Population cohort study using 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, age 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 other differences in comorbidities. During total follow-up of 431,086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs men (95% CI 0.87-0.92; p<0.001), and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83-0.91; p<0.001). This was driven by lower mortality in women (HR 0.86, 0.83-0.89; p<0.001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 0.94-1.07; p=0.87), any stroke or any thromboembolism (1.02, 0.96-1.07; p=0.58), and incident vascular dementia (1.13, 0.97-1.32; p=0.11). 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 operator curve area 0.651 vs 0.639; p<0.001), and no interaction with gender (p=0.45).Conclusions: Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation.

KW - Atrial fibrillation

KW - Gender

KW - Women

KW - Sex

KW - Stroke

KW - Thromboembolism

UR - https://academic.oup.com/eurheartj

U2 - 10.1093/eurheartj/ehae539

DO - 10.1093/eurheartj/ehae539

M3 - Article

C2 - 39217497

SN - 0195-668X

VL - 45

JO - European Heart Journal

JF - European Heart Journal

IS - 36

M1 - ehae539

ER -

Gender and contemporary risk of adverse events in atrial fibrillation

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Keywords

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Projects

Preventing stroke, premature death and cognitive decline in a broader community of patients with atrial fibrillation using healthcare data for pragmatic research (DaRe2THINK)

Cite this