The following is a summary of “SEX DIFFERENCES IN RHYTHM CONTROL STRATEGIES AND ATRIAL FIBRILLATION (AF) RECURRENCE AMONG PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT (ED) WITH AF IN 47 COUNTRIES,” published in the March 2023 issue of Cardiology by Jiang et al.

Atrial fibrillation (AF) is a common condition, and the sex differences in its management in the emergency department (ED) and subsequent AF recurrence remain poorly understood across the globe. 

To address this, researchers conducted a study of patients presenting to an ED with AF as their primary diagnosis using the global RE-LY AF registry (n=15,400), with one-year follow-up. The study included 6,684 patients, 47.3% of whom were female. The researchers examined sex differences globally and by World Bank regions and analyzed the effect of female sex on AF rehospitalization using logistic regression with clustering on geographic regions and age adjustment alone or with risk factors and comorbidities. The mean age at inclusion was 61.6 ±14.3 for males and 65.4 ±14.6 for females, P<0.0001, with females having higher CHADS2 scores (1.5±1.3 vs. 1.3±1.2 P<0.001) and higher heart rates in the ED (111±31 vs. 107±32 P<0.0001 bpm). 

There were substantial regional variations in treatment strategies and outcomes. Females were less likely to be treated with rhythm control strategy and more likely to experience AF recurrence or persistence, as well as AF rehospitalization. In South America, females were more likely to be rehospitalized with AF. However, in the global multivariable model, there was no statistically significant association between the female sex and AF rehospitalization or recurrence/persistence. The study concluded that globally, rhythm control treatment and AF ablation were less likely to be used in females, and the rate of rehospitalization for AF after an ED visit was higher among females.

Source: jacc.org/doi/10.1016/S0735-1097%2823%2900447-3