The DOI matches its Crossref record; 178 of the 178 references it cites were found in a registry or an index; 5 of the 143 sources its claims cite were checked for support.
Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis
Open accessAbstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide. During the past century, a range of risk factors has been associated with AF, severe complications from the arrhythmia have been identified, and its prevalence has been increasing steadily. Whereas evidence has accumulated regarding sex-specific differences in coronary heart disease and stroke, the differences between women and men with AF has received less attention. We review the current literature on sex-specific differences in the epidemiology of AF, including incidence, prevalence, risk factors, and genetics, and in the pathophysiology and the clinical presentation and prognosis of patients with this arrhythmia. We highlight current knowledge gaps and areas that warrant future research, which might advance understanding of variation in the risk factors and complications of AF, and ultimately aid more-tailored management of the arrhythmia.
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TL;DR
This narrative review summarizes sex differences in atrial fibrillation (AF) epidemiology, pathophysiology, presentation, and prognosis, noting lower incidence and prevalence in women but higher symptom burden, stroke risk, and some mortality risk. It highlights major knowledge gaps, especially limited pathophysiologic and non-North American/European data and lack of formal sex-interaction testing.
Key findings
- AF prevalence is lower in women (373 per 100,000) than men (596 per 100,000); age-adjusted incidence in North America/Europe is 1.5–2 times higher in men, with Framingham and Olmsted County incidence rates of 1.6 and 2.7 per 1000 person-years in women versus 3.8 and 4.7 in men.
- Lifetime risk is similar in North American/European populations (Framingham at age 60: 23.4% in women vs 25.8% in men; Rotterdam at age 55: 22.2% vs 23.8%), but a Chinese population study reported higher lifetime risk in women than men (22.2% vs 16.7%).
- Women with AF are more likely to be symptomatic and less likely to have asymptomatic AF (RR 0.57; 95% CI 0.52–0.64), more often seek care, and have worse quality of life; female sex is an independent risk factor for AF-related stroke (e.g., Framingham HR 1.92, 95% CI 1.2–3.07; ATRIA RR 1.6, 95% CI 1.3–1.9).
- Mortality findings are inconsistent across studies, but a meta-analysis of 19 studies found higher all-cause mortality in women than men with AF (women-to-men RR 1.12, 95% CI 1.07–1.17); sex differences in AF-related heart failure, myocardial infarction, and dementia remain less clear.
Methods
- Design: narrative review of the literature on sex-specific differences in AF epidemiology, pathophysiology, clinical presentation, and prognosis.
- Data/sample: published studies, including cohort, registry, randomized trial, and meta-analysis data, with supplementary tables; no primary patient sample was analyzed.
- Main analysis: narrative synthesis of incidence, prevalence, risk factors, genetics, pathophysiology, presentation, and prognosis, with identification of knowledge gaps and future research directions.
Limitations
- The authors state that studies investigating sex-related differences in AF pathophysiology are limited and mechanisms remain inadequately understood.
- The authors state that many studies had limited sample size and did not formally test for effect modification by sex; data from outside North America and Europe are sparse, and findings may not generalize to other ethnic groups.
- Evident from the text: as a narrative review, it does not report a systematic search strategy, inclusion criteria, or formal quality/risk-of-bias assessment; mortality comparisons are also challenged by substantial differences in follow-up time across studies.
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Claims the paper makes
5 of 143 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Several studies evaluating familial aggregation of AF have reported substantially increased risk of AF in individuals with affected family members.8,9,50–55”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Genetics
What the sources say
- Supportedcites [8] Oyen, N. et al. Familial aggregation of lone atrial fibrillation in young persons. J. Am. Coll. Cardiol. 60, 917–921 (2012). source
The Results report that lone AF occurred at 3.5 times the rate in people with an affected first-degree relative compared with those without one. This supports the cited paper as one of the studies described, although its finding specifically concerns lone AF in people under 60. Page numbers were not supplied. (LLM, conf=0.91)
- Supportedcites [9] Zoller, B., Ohlsson, H., Sundquist, J. & Sundquist, K. High familial risk of atrial fibrillation/atrial flutter in multiplex families: a nationwide family study in Sweden. J. Am. Heart Assoc. 2, e003384 (2013). source
The Discussion reports that this Swedish study found increased familial risk of AF/AFl and that its estimates were similar to those of three previous studies of familial AF risk. The Results also report substantially higher odds among people with affected parents and siblings. (LLM, conf=0.92)
- Could not verifycites [50] Drca, N., Wolk, A., Jensen-Urstad, M. & Larsson, S. C. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart 101, 1627–1630 (2015). sourceExperimental — accuracy not yet measured
The Results discuss physical activity and AF risk, not familial aggregation. The Statistical analysis section mentions family history of myocardial infarction as an adjustment variable, but gives no finding about AF risk in people with affected family members. Searches for familial aggregation and family history of AF found no supporting passage in our copy. (LLM, conf=0.76)
- Not checked yetcites [51] Arnar, D. O. et al. Familial aggregation of atrial fibrillation in Iceland. Eur. Heart J. 27, 708–712 (2006). source
- Partly supportedcites [52] Chen, L. Y., Herron, K. J., Tai, B. C. & Olson, T. M. Lone atrial fibrillation: influence of familial disease on gender predilection. J. Cardiovasc. Electrophysiol. 19, 802–806 (2008). sourceExperimental — accuracy not yet measured
The Results (page unavailable) report that 78 of 192 patients with lone AF had an affected first- or second-degree relative, supporting familial aggregation. The study does not compare AF risk in people with and without affected relatives, so it does not establish the claimed substantially increased risk. (LLM, conf=0.81)
- Supportedcites [53] Christophersen, I. E. et al. Familial aggregation of atrial fibrillation: a study in Danish twins. Circ. Arrhythm. Electrophysiol. 2, 378–383 (2009). source
The Study limitations passage says that children of parents with AF have nearly double or greater risk. The paper’s Conclusion also reports increased AF risk for a monozygotic twin whose co-twin has AF. Together, these support this paper as one of the cited studies reporting elevated risk among people with affected family members. (LLM, conf=0.92)
- Not checked yetcites [54] Ellinor, P. T., Yoerger, D. M., Ruskin, J. N. & MacRae, C. A. Familial aggregation in lone atrial fibrillation. Hum. Genet. 118, 179–184 (2005). source
- Not checked yetcites [55] Fox, C. S. et al. Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring. JAMA 291, 2851–2855 (2004). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
None of the sources cited for this claim have been checked yet.
In the paper
“Similarly to incidence, age-adjusted prevalence of AF has been reported to be lower in women than in men in North America and Europe (Figure 2) (Supplementary Tables S3 and S4).”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
- Not checked yetcites [18] Wilke, T. et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 15, 486–493 (2013). source
- Not checked yetcites [19] Piccini, J. P. et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007. Circ. Cardiovasc. Qual. Outcomes 5, 85–93 (2012). source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“In North American and European populations, the age-adjusted incidence of AF has been estimated to be 1.5 to 2 times higher in men than in women (Supplementary Tables S1 and S2).”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
- Not checked yetcites [15] Benjamin, E. J. et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98, 946–952 (1998). source
- Not checked yetcites [1] Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014). source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“AF incidence has been shown to increase disproportionately with increasing age in both women and men, reaching as high as 30.4 per 1000 person-years in women and 32.9 per 1000 person-years in men by age 85–89 years.17”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [17] Chien, K. L. et al. Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese. Int. J. Cardiol. 139, 173–180 (2010). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“Because women typically live longer than men, the absolute number of women exceeds the number of men with AF in Medicare data.18”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [18] Wilke, T. et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 15, 486–493 (2013). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“The estimated prevalence is lower in women (373 per 100,000) than in men (596 per 100,000).1”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Abstract
What the sources say
- Not checked yetcites [1] Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014). source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“However, after adjusting for height and other AF risk factors, a multivariable risk score for incident AF in a three-cohort study showed male sex was no longer significantly associated with AF.32”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [32] Guo, Y. et al. Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest 147, 109–119 (2015). source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“In the Rotterdam Study, the lifetime risks for women and men at age 55 years were 22.2% and 23.8%, respectively.30”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [30] Lloyd-Jones, D. M. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110, 1042–1046 (2004). source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“The overall prevalence of AF varies by ancestry; prevalence studies of Asian populations have been less consistent than those of North American and European poulations.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [20] Svennberg, E. et al. Mass screening for untreated atrial fibrillation: the STROKESTOP Study. Circulation 131, 2176–2184 (2015). source
- Not checked yetcites [21] Li, Y. et al. Prevalence of atrial fibrillation in China and its risk factors. Biomed. Environ. Sci. 26, 709–716 (2013).
- Not checked yetcites [22] Zhou, Z. & Hu, D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J. Epidemiol. 18, 209–216 (2008). source
- Not checked yetcites [23] Yap, K. B., Ng, T. P. & Ong, H. Y. Low prevalence of atrial fibrillation in community-dwelling Chinese aged 55 years or older in Singapore: a population-based study. J. Electrocardiol. 41, 94–98 (2008). source
- Not checked yetcites [24] Jeong, J. H. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years. J. Korean Med. Sci. 20, 26–30 (2005). source
- Not checked yetcites [25] Inoue, H. et al. Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination. Int. J. Cardiol. 137, 102–107 (2009). source
- Not checked yetcites [26] Iguchi, Y. et al. Prevalence of atrial fibrillation in community-dwelling Japanese aged 40 years or older in Japan: analysis of 41,436 non-employee residents in Kurashiki-city. Circ. J. 72, 909–913 (2008). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Two large cross-sectional studies of Chinese cohorts reported that age-adjusted prevalence of AF was similar in women and men (0.76% versus 0.78% and 0.63% versus 0.66%),20,21”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [20] Svennberg, E. et al. Mass screening for untreated atrial fibrillation: the STROKESTOP Study. Circulation 131, 2176–2184 (2015). source
- Not checked yetcites [21] Li, Y. et al. Prevalence of atrial fibrillation in China and its risk factors. Biomed. Environ. Sci. 26, 709–716 (2013).
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 22
- The quote only partly states this claim. 1
- Probably not a substantial claim. 5
None of the sources cited for this claim have been checked yet.
In the paper
“in women, AF is associated with worse symptoms and quality of life,10–12 and increased risk of complications such as stroke13 and mortality,14 compared with men.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Abstract
What the sources say
- Not checked yetcites [13] Humphries, K. H. et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 103, 2365–2370 (2001). source
- Not checked yetcites [14] Bushnell, C. et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45, 1545–1588 (2014). source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The lower AF incidence among women seems to be consistently observed outside North America and Europe, although fewer studies are available.1,16”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [1] Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014). source
- Not checked yetcites [16] Miyasaka, Y. et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 114, 119–125 (2006). source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies indicate that among individuals with AF, women are more likely than men to experience symptoms,60,11,12 and to seek care for these symptoms.10,11”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Abstract
What the sources say
- Not checked yetcites [10] Ball, J., Carrington, M. J., Wood, K. A., Stewart, S. & Investigators, S. Women versus men with chronic atrial fibrillation: insights from the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY). PLoS ONE 8, e65795 (2013). source
- Not checked yetcites [11] Scheuermeyer, F. X. et al. There are sex differences in the demographics and risk profiles of emergency department (ED) patients with atrial fibrillation and flutter, but no apparent differences in ED management or outcomes. Acad. Emerg. Med. 22, 1067–1075 (2015). source
- Not checked yetcites [12] Xiong, Q., Proietti, M., Senoo, K. & Lip, G. Y. Asymptomatic versus symptomatic atrial fibrillation: a systematic review of age/gender differences and cardiovascular outcomes. Int. J. Cardiol. 191, 172–177 (2015). source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In men, a U-shaped association has been reported, in which sedentary lifestyle and vigorous exercise both are associated with increased AF risk,41,44,45 whereas moderate activity is protective.46”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [41] Larsson, S. C., Drca, N. & Wolk, A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis. J. Am. Coll. Cardiol. 64, 281–289 (2014). source
- Not checked yetcites [44] Aviles, R. J. et al. Inflammation as a risk factor for atrial fibrillation. Circulation 108, 3006–3010 (2003). source
- Not checked yetcites [45] Aizer, A. et al. Relation of vigorous exercise to risk of atrial fibrillation. Am. J. Cardiol. 103, 1572–1577 (2009). source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In women, vigorous exercise has not been shown to increase AF risk, although moderate exercise is associated with a lower risk of AF than sedentary lifestyle.47,48”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [47] Mozaffarian, D., Furberg, C. D., Psaty, B. M. & Siscovick, D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 118, 800–807 (2008). source
- Not checked yetcites [48] Everett, B. M. et al. Physical activity and the risk of incident atrial fibrillation in women. Circ. Cardiovasc. Qual. Outcomes 4, 321–327 (2011). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Women with AF have higher prevalence of hypertension and valvular heart disease and lower prevalence of coronary heart disease than men with AF.5,11,34”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
- Not checked yetcites [11] Scheuermeyer, F. X. et al. There are sex differences in the demographics and risk profiles of emergency department (ED) patients with atrial fibrillation and flutter, but no apparent differences in ED management or outcomes. Acad. Emerg. Med. 22, 1067–1075 (2015). source
- Not checked yetcites [34] Wang, T. J. et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 292, 2471–2477 (2004). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, globally, the prevalence of valvular heart disease among individuals with AF is still greater than 25%,38,39 largely caused by the higher incidence of rheumatic heart disease in low-income and middle-income countries.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [38] Huxley, R. R. et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation 123, 1501–1508 (2011). source
- Not checked yetcites [39] Chiang, C. E. et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ. Arrhythm. Electrophysiol. 5, 632–639 (2012). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“A population-based study from China showed similar lifetime risk for women at age 55 years (22.2%); however, in contrast to North American populations, the lifetime risk for women in China was higher than that for men (22.2% versus 16.7%).31”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [31] Heeringa, J. et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur. Heart J. 27, 949–953 (2006). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In particular, body mass index has increased significantly (Figure 3).5”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
In the paper
“In 2005, Ravn et al. discovered a genetic variant in the X-linked gene KCNE5 that was more frequent in 96 controls than in 158 patients with AF, and that was found to be protective of AF.57”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Genetics
What the sources say
- Not checked yetcites [57] Lubitz, S. A. et al. Association between familial atrial fibrillation and risk of new-onset atrial fibrillation. JAMA 304, 2263–2269 (2010). source
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The plasma concentrations of the inflammatory marker C-reactive protein143 and of fibroblast growth factor-23144 have been found to be higher in women than in men in epidemiological studies.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Pathophysiology > Structural properties
What the sources say
- Not checked yetcites [143] Wang, T. J. et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 107, 2920–2925 (2003). source
- Not checked yetcites [144] Miyasaka, Y. et al. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Eur. Heart J. 27, 936–941 (2006). source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Women generally have reduced ventricular wall thickness and smaller left atria and ventricles compared with men.138–141”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Pathophysiology > Structural properties
What the sources say
- Not checked yetcites [138] Horstmann, S. et al. Atrial fibrillation and prestroke cognitive impairment in stroke. J. Neurol. 261, 546–553 (2014). source
- Not checked yetcites [139] Bunch, T. J. et al. Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia. Heart Rhythm 7, 433–437 (2010). source
- Not checked yetcites [140] Dublin, S. et al. Atrial fibrillation and risk of dementia: a prospective cohort study. J. Am. Geriatr. Soc. 59, 1369–1375 (2011). source
- Not checked yetcites [141] Forti, P. et al. Atrial fibrillation and risk of dementia in non-demented elderly subjects with and without mild cognitive impairment (MCI). Arch. Gerontol. Geriatr. 44 (Suppl. 1), 155–165 (2007). source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“the Copenhagen ECG Study showed that both long and short PR intervals were associated with increased risk of AF in women, whereas only longer PR intervals were associated with AF in men.159”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Pathophysiology > Hormones
What the sources say
- Not checked yetcites [159] Marijon, E. et al. Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study. Circulation 128, 2192–2201 (2013). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“None of the genetic risk scores developed thus far have reported sex differences in AF prediction.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Genetics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“In a study of patients visiting the emergency department, women were more likely to have longer duration of symptoms and to present with atypical symptoms, such as weakness and fatigue.11,12”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Clinical presentation
What the sources say
- Not checked yetcites [11] Scheuermeyer, F. X. et al. There are sex differences in the demographics and risk profiles of emergency department (ED) patients with atrial fibrillation and flutter, but no apparent differences in ED management or outcomes. Acad. Emerg. Med. 22, 1067–1075 (2015). source
- Not checked yetcites [12] Xiong, Q., Proietti, M., Senoo, K. & Lip, G. Y. Asymptomatic versus symptomatic atrial fibrillation: a systematic review of age/gender differences and cardiovascular outcomes. Int. J. Cardiol. 191, 172–177 (2015). source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Women seem to be more likely to seek care for symptoms, which might partly be attributable to higher mean heart rates at presentation.10,11”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Clinical presentation
What the sources say
- Not checked yetcites [10] Ball, J., Carrington, M. J., Wood, K. A., Stewart, S. & Investigators, S. Women versus men with chronic atrial fibrillation: insights from the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY). PLoS ONE 8, e65795 (2013). source
- Not checked yetcites [11] Scheuermeyer, F. X. et al. There are sex differences in the demographics and risk profiles of emergency department (ED) patients with atrial fibrillation and flutter, but no apparent differences in ED management or outcomes. Acad. Emerg. Med. 22, 1067–1075 (2015). source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In a rabbit model, left atrial and pulmonary vein tissue from females displayed longer action potential duration, and female pulmonary vein tissue had a more negative resting membrane potential compared with males.147”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Pathophysiology > Electrical properties
What the sources say
- Not checked yetcites [147] Stewart, S., Hart, C. L., Hole, D. J. & McMurray, J. J. V. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am. J. Med. 113, 359–364 (2002). source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Multiple longitudinal studies have evaluated whether an interaction exists between sex and AF-related risk of mortality, but the results have not been consistent (Supplementary Table S10).”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Prognosis > Mortality
What the sources say
- Not checked yetcites [14] Bushnell, C. et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45, 1545–1588 (2014). source
- Not checked yetcites [72] Nattel, S., Burstein, B. & Dobrev, D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ. Arrhythm. Electrophysiol. 1, 62–73 (2008). source
- Not checked yetcites [108] Clayton, J. A. & Collins, F. S. Policy: NIH to balance sex in cell and animal studies. Nature 509, 282–283 (2014). source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“A study from Groningen, Netherlands found that AF is an independent risk factor for new-onset HF with preserved ejection fraction in women, but not in men.98”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Prognosis > Heart failure
What the sources say
- Not checked yetcites [98] Stramba-Badiale, M., Locati, E. H., Martinelli, A., Courville, J. & Schwartz, P. J. Gender and the relationship between ventricular repolarization and cardiac cycle length during 24-h Holter recordings. Eur. Heart J. 18, 1000–1006 (1997). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The bulk of studies evaluating sex differences in the AF-related risk of HF have showed no significant difference; however, a few studies have suggested higher risk in women (Supplementary Table S8).”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Prognosis > Heart failure
What the sources say
- Not checked yetcites [97] Liu, X. K. et al. Gender difference in the cycle length-dependent QT and potassium currents in rabbits. J. Pharmacol. Exp. Ther. 285, 672–679 (1998). source
- Not checked yetcites [98] Stramba-Badiale, M., Locati, E. H., Martinelli, A., Courville, J. & Schwartz, P. J. Gender and the relationship between ventricular repolarization and cardiac cycle length during 24-h Holter recordings. Eur. Heart J. 18, 1000–1006 (1997). source
- Not checked yetcites [99] Nielsen, J. B. et al. Risk of atrial fibrillation as a function of the electrocardiographic PR interval: results from the Copenhagen ECG Study. Heart Rhythm 10, 1249–1256 (2013). source
- Not checked yetcites [100] Cheng, S. et al. Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA 301, 2571–2577 (2009). source
- Not checked yetcites [101] Buitrago, C., Massheimer, V. & de Boland, A. R. Acute modulation of Ca2+ influx on rat heart by 17β-estradiol. Cell. Signal. 12, 47–52 (2000). source
- Not checked yetcites [102] Jovanovic, S., Jovanovic, A., Shen, W. K. & Terzic, A. Low concentrations of 17β-estradiol protect single cardiac cells against metabolic stress-induced Ca2+ loading. J. Am. Coll. Cardiol. 36, 948–952 (2000). source
- Not checked yetcites [103] Magnani, J. W. et al. Association of sex hormones, aging, and atrial fibrillation in men: the Framingham Heart Study. Circ. Arrhythm. Electrophysiol. 7, 307–312 (2014). source
Strength:plain· not yet calibratedn = 725Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Elevated body mass index, hypertension, diabetes mellitus, coronary heart disease, valvular heart disease, and heart failure (HF) constitute major risk factors for AF, but the prevalence of these risk factors vary between women and men.3–5”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Abstract
What the sources say
- Not checked yetcites [3] Tedrow, U. B. et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). J. Am. Coll. Cardiol. 55, 2319–2327 (2010). source
- Not checked yetcites [4] Benjamin, E. J. et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 271, 840–844 (1994). source
- Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In North American populations, despite higher incidence of AF in men, lifetime risk of AF in women and men were similar owing to longer life expectancy for women.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Incidence, prevalence, and lifetime risk
What the sources say
- Not checked yetcites [29] Majeed, A., Moser, K. & Carroll, K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart 86, 284–288 (2001). source
- Not checked yetcites [30] Lloyd-Jones, D. M. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110, 1042–1046 (2004). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Advancing age is the most important risk factor, leading to about a doubling in AF incidence with every 10-year increase in age.4”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Risk factors
What the sources say
- Not checked yetcites [4] Benjamin, E. J. et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 271, 840–844 (1994). source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Since women have two copies of the X chromosome whereas men have one, the investigators suggested that the variant might contribute to the lower prevalence of AF in women.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Epidemiology > Genetics
What the sources say
- Not checked yetcites [57] Lubitz, S. A. et al. Association between familial atrial fibrillation and risk of new-onset atrial fibrillation. JAMA 304, 2263–2269 (2010). source
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The reported literature suggest that sex differences in hormones and in electrical and structural characteristics might help explain variation in incidence, prevalence, burden, and complications associated with AF in women and men.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Pathophysiology > Hormones
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The AF-related sex differences in epidemiology, risk factors, and outcomes identified in populations of European ancestry might not be generalizable to other ethnic groups.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Future directions
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Notably, the meta-analysis included disease-based samples and the results might thus not be generalizable to the general population.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Prognosis > Mortality
What the sources say
- Not checked yetcites [120] Friberg, J., Scharling, H., Gadsboll, N., Truelsen, T. & Jensen, G. B. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study). Am. J. Cardiol. 94, 889–894 (2004). source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Although the pathophysiology of AF has been investigated extensively through the years,170 our understanding of the differences between male and female cardiac anatomy and electrical mechanisms, which might contribute to difference in risks and prognosis of AF by sex, is insufficient.”
§ Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis > Future directions
What the sources say
- Not checked yetcites [170] Nattel, S. New ideas about atrial fibrillation 50 years on. Nature 415, 219–226 (2002). source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The paper relies on this without support.
AF is the most common sustained arrhythmia in women and men worldwide.
“Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide.”
The paper relies on this without support.
Little is known about the underlying mechanisms of the increased risk of stroke in women with atrial fibrillation.
“Nonetheless, little is known of the underlying mechanisms.”
The paper relies on this without support.
Little attention has been paid to potential sex differences in the atrial fibrillation-related risks of heart failure, myocardial infarction, and dementia.
“To date, little attention has been paid to potential sex differences in the AF-related risks of HF, MI, and dementia.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“In both developed and developing countries, the age-adjusted incidence and prevalence of AF are lower in women, while the risk of death in women with AF is similar to or higher than that in men with AF. 1,46,47”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [47]
In the citing paper
“In both developed and developing countries, the age-adjusted incidence and prevalence of AF are lower in women, while the risk of death in women with AF is similar to or higher than that in men with AF. 1,46,47”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [47]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Sex-specific CHA2DS2-VASc scores are reversed
MinorThe paper first assigns a score of 0 to men and 1 to women in the MI analysis, then assigns scores of 0 and 1 to women and men, respectively. The latter also conflicts with the paper's statement that female sex itself earns one point.
“AF also has been shown to be a risk factor for MI in men with CHA2DS2-VASc=0 and women with CHA2DS2-VASc=1.107”
“In a separate analysis of women and men with CHA2DS2-VASc scores of 0 and 1, respectively”
Reported hazard ratio lies outside its confidence interval
MinorThe reported Swedish hazard ratio of 1.18 is above the upper bound of its reported 95% confidence interval, 1.15.
“Swedish (HR 1.18”
“95% CI 1.05–1.15)”
Citations
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2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab484 · Cited by 6,485
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Stærk, L., Sherer, J. A., Ko, D., Benjamin, E. J., & Helm, R. H. (2017) · Circulation Research · doi:10.1161/circresaha.117.309732 · Cited by 1,267
Self-citation
Metadata
- Authors
- Ko, D., Rahman, F., Schnabel, R. B., Yin, X., Benjamin, E. J., & Christophersen, I. E.
- Affiliations
- Boston University (US)
- Universität Hamburg (DE)
- Vestre Viken Hospital Trust (NO)
- Corresponding author
- Christophersen, Ingrid E.
- ORCID
- Venue
- Nature Reviews Cardiology
- Published
- 2016-04-07
- Volume
- 13
- Issue
- 6
- Pages
- 321-332
- ISSN
- 1759-5002 (ISSN-L)
- 1759-5010
- PMC
- PMC5579870
- OpenAlex
- W2322257236
- Semantic Scholar
- 1d4b97cb3df2f8a8056dfdb009b6158ca5720889
- Cited by
- 353
- References
- 178
- Citations by year
- 2026: 29 · 2025: 43 · 2024: 41 · 2023: 37 · 2022: 43 · 2021: 40 · 2020: 37 · 2019: 27 · 2018: 26 · 2017: 20 · 2016: 9
- FWCI
- 4.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Nature Reviews Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000157, n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (HHSN268201500001I, HHSN268201500001C, R01HL128914, R01HL102214, T32HL007224, N01-HC-025195, RC1HL101056, R01HL092577)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, sex differences, women, epidemiology, pathophysiology, risk factors, clinical features, prognosis, arrhythmia complications
- MeSH terms
- Atrial Fibrillation, Female, Humans, Prognosis, Risk Factors, Sex Factors, Incidence, Prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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