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Sex, Atrial Fibrillation, and Long-Term Mortality After Cardiac Surgery.

Sergey Karamnov1, Natalia Sarkisian2, Jakob Wollborn1

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

JAMA Network Open
|August 21, 2024
PubMed
Summary

Women undergoing cardiac surgery have a lower risk of postoperative atrial fibrillation (poAF) but a higher long-term mortality risk if poAF develops. This highlights the need for sex-specific care strategies.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Epidemiology

Background:

  • Limited data exist on sex differences in postoperative atrial fibrillation (poAF) incidence and its long-term mortality impact after cardiac surgery.
  • Understanding these disparities is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To investigate whether the incidence of poAF and associated long-term mortality after cardiac surgery differ between sexes.
  • To identify potential sex-based variations in risk and outcomes.

Main Methods:

  • Retrospective cohort study of 21,568 adult patients undergoing cardiac surgery at two tertiary care centers (2002-2016).
  • Analysis included medical records, electrocardiograms (EKGs), and Society of Thoracic Surgeons database information.
  • Outcomes assessed were poAF incidence and all-cause mortality, with follow-up until 2022.

Main Results:

  • Women had a lower incidence of poAF (40.8%) compared to men (38.8%), with multivariable analysis showing a reduced risk in women (OR, 0.85).
  • However, women who developed poAF experienced a significantly higher mortality hazard (HR, 1.31) compared to men with poAF (HR, 1.17).
  • The association between poAF and mortality was significantly modified by sex.

Conclusions:

  • Women undergoing cardiac surgery are less likely to develop poAF but face a greater long-term mortality risk if it occurs.
  • These findings underscore the necessity for tailored perioperative care strategies for women undergoing cardiac surgery.
  • Further research into sex-specific mechanisms and interventions is warranted.