New-Onset Atrial Fibrillation: Sex Differences in Presentation, Treatment, and Outcome
Abstract
Background —Although sex differences in coronary artery disease have received considerable attention, few studies have dealt with sex differences in the most common sustained cardiac arrhythmia, atrial fibrillation (AF). Differences in presentation and clinical course may dictate different approaches to detection and management. We sought to examine sex-related differences in presentation, treatment, and outcome in patients presenting with new-onset AF. Methods and Results —The Canadian Registry of Atrial Fibrillation (CARAF) enrolled subjects at the time of first ECG-confirmed diagnosis of AF. Participants were followed at 3 months, at 1 year, and annually thereafter. Treatment was at the discretion of the patients’ physicians and was not directed by CARAF investigators. Baseline and follow-up data collection included a detailed medical history, clinical, ECG, and echocardiographic measures, medication history, and therapeutic interventions. Three hundred thirty-nine women and 560 men were followed for 4.14±1.39 years. Compared with men, women were older at the time of presentation, more likely to seek medical advice because of symptoms, and experienced significantly higher heart rates during AF. Compared with older men, older women were half as likely to receive warfarin and twice as likely to receive acetylsalicylic acid. Compared with men on warfarin, women on warfarin were 3.35 times more likely to experience a major bleed. Conclusions —Anticoagulants are underused in older women with AF relative to older men with AF, despite comparable risk profiles. Women receiving warfarin have a significantly higher risk of major bleeding, suggesting the need for careful monitoring of anticoagulant intensity in women.
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In women, AF is associated with worse symptoms and quality of life, and increased risk of complications such as stroke and mortality, compared with men.
“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.”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [13]
Female sex is a well-recognized, independent risk factor for AF-related stroke and systemic thromboembolism.
“Female sex is a well-recognized, independent risk factor for AF-related stroke13 and systemic thromboemblism.63–65”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [13]
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- Authors
- Humphries, K. H., Kerr, C. R., Connolly, S. J., Klein, G., Boone, J. A., Green, M., Sheldon, R., Talajic, M., Dorian, P., & Newman, D.
- Affiliations
- Western University (CA)
- ORCID
- Venue
- Circulation
- Published
- 2001-05-15
- Volume
- 103
- Issue
- 19
- Pages
- 2365-2370
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2068229127
- Cited by
- 378
- References
- 29
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 13 · 2023: 8 · 2022: 19 · 2021: 24 · 2020: 12 · 2019: 16 · 2018: 23 · 2017: 25 · 2016: 22 · 2015: 26 · 2014: 19 · 2013: 20 · 2012: 27
- FWCI
- 5.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- new-onset atrial fibrillation, sex differences, women, anticoagulation, warfarin, major bleeding, aspirin, stroke prevention, older women, heart rate, clinical features
- MeSH terms
- Anticoagulants, Atrial Fibrillation, Cardiovascular Diseases, Cause of Death, Electrocardiography, Female, Follow-Up Studies, Hemorrhage, Humans, Male, Middle Aged, Myocardial Infarction, Registries, Sex Factors, Warfarin, Cohort Studies, Survival Rate, Treatment Outcome, Stroke
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