Eur Heart J Qual Care Clin Outcomes. 2021 Dec 21:qcab096. doi: 10.1093/ehjqcco/qcab096. Online ahead of print.
OBJECTIVE: This study aimed to investigate the impact of sex on the clinical profile, utilization of rhythm control therapies, cost of hospitalization, length of stay, and in-hospital mortality in patients admitted for atrial fibrillation (AF) in the United States.
METHODS: We used data from the Nationwide Inpatient Sample (NIS) for the year 2018. Regression analysis was performed to investigate differences between men and women. A p value ≤ 0.05 was considered significant.
RESULTS: A total of 82592 patients were admitted with a primary diagnosis of AF, 50.8% women. Women were significantly older (mean age 74 vs 67 years, p <0.001), and had a higher CHA2DS2-VASc score (median 4 vs 2, p <0.001) than men. Women had relatively higher in-hospital mortality (0.9% vs 0.8%, p = 0.070), however, after risk adjustment female sex was no longer a predictor of mortality (p = 0.199). In sex-specific regression analyses, increased age, chronic obstructive pulmonary disease, previous stroke, heart failure, and chronic kidney disease were risk factors for in-hospital mortality in both sexes, vascular disease only in women, race and alcohol abuse only in men. After adjusting for potential confounders, female sex was associated with lower likelihood of receiving catheter ablation (adjusted odds ratio [aOR] 0.69, 95% CI 0.64-0.74) and electrical cardioversion (aOR 0.69, 95% CI 0.67-0.72), and with longer hospitalization (aOR 1.33, 95% CI 1.28-1.37), whereas sex had no influence on hospitalization costs (p = 0.339).
CONCLUSION: There were differences in the risk profile, management, and outcomes between men and women hospitalized for AF. Further studies are needed to explore why women are treated differently regarding rhythm control procedures.