Women with atrial fibrillation: Greater risk, less attention

In 1995, atrial fibrillation (AF) was estimated to affect 2.2 million people in the United States. After the age of 75 years (the median age for onset of AF), approximately 60% of people with AF are women. Women have a significantly higher risk of AF-related stroke than do men and are more likely to live with stroke-related disability and a significantly lower quality of life.

This article provides an overview of the contributing factors and clinical presentation of AF in women and offers a rational, safe, effective, and gender-specific approach to therapy for women with AF.

Search engines, including PubMed and Google Scholar, were used to review the English-language literature addressing AF gender differences for the years 1989-2009. The search term atrial fibrillation was combined with multiple other terms, as well as with female, gender, sex, or women. Full-length manuscripts were reviewed. Original studies obtained were searched for additional relevant manuscripts using the cited references.

Studies have shown that women are more likely than men to experience symptomatic attacks, a higher frequency of recurrences, and significantly higher heart rates during AF. Hormonal fluctuations during the menstrual cycle that affect QT intervals are an important consideration when selecting antiarrhythmic drugs for premenopausal women. Women are treated with statins less frequently than are men, possibly contributing to an increased incidence of AF in women. Women may have a higher incidence of AF because of the association with obesity. Some evidence suggests that women have a significantly higher risk of bleeding from anticoagulation. Reluctance among physicians and patients to use warfarin may be especially problematic in elderly women, who benefit most from it. Outcomes after catheter ablation for AF are similar between the sexes, yet women are referred later and less frequently.

We favor emphasizing therapies to prevent AF and ensure safe arrhythmia management (ie, rate control and appropriate anticoagulation) once AF has been diagnosed. Gender differences should be kept in mind for women with AF to reduce risks and improve quality of life.