Sex-related differences in presentation, treatment, and outcomes of Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry
Authors: Bucci Tommaso , Shantsila Alena , Romiti Giulio Francesco , Teo Wee-Siong , Park Hyung-Wook , Shimizu Wataru , Mei Davide Antonio , Tse Hung-Fat , Proietti Marco , Chao Tze-Fan , Lip Gregory Y. H. ,   Asia-Pacific Heart Rhythm Society Atrial Fibrillation Registry Investigators, David Chun-Wah Siu , Shimizu Wataru , Yodogawa Kenji , Tsutsui Hiroyuki , Mukai Yasushi , Tomita Hirofumi , Horiuchi Daisuke , Hagii Joji , Aonuma Kazutaka , Okumura Yasuo , Goya Masahiko , Hirao Kenzo , Ajioka Masayoshi , Hagiwara Nobuhisa , Suzuki Atsushi , Yamane Teiichi , Ikeda Takanori , Yuzawa Hitomi , Satomi Kazuhiro , Yazaki Yoshinao , Fukuda Keiichi , Kobayashi Yoshinori , Morita Norishige , Murohara Toyoaki , Watanabe Eiichi , Harada Masahide , Sakagami Satoru , Saeki Takahiro , Kusano Kengo , Miyamoto Koji , Miyazaki Shinsuke , Tada Hiroshi , Inoue Koichi , Tanaka Nobuaki , Koretsune Yukihiro , Abe Haruhiko , Kihara Yasuki , Nakano Yukiko , Shimizu Akihiko , Yoshiga Yasuhiro , Sakamoto Tomohiro , Okumur Ken , Takahashi Naohiko , Shinohara Tetsuji , Soejima Kyoko , Takagi Masahiko , Kawamura Mitsuharu , Munetsugu Yumi , Kim Sung-Hwan , Shim Jae-Min , Uhm Jae Sun , Im Sung Il , Par Hyoung-Seob , Kim Jun Hyung , On Young Keun , Oh Il-Young , Shin Seung Yong , Ko Jum Suk , Park Jun Beom , Teo Wee-Siong , Won Kelvin Cheok-Keng , Lim Toon-Wei , Foo David , Chen Shih-Ann , Chen Shih-Ann , Chao Tze-Fan , Lin Yenn-Jiang , Chung Fa-Po , Hu Yu-Feng , Chang Shil-Lin , Tuan Ta-Chuan , Liao Jo-Nan , Li Cheng-Hung , Huang Jin-Long , Hsieh Yu-Cheng , Wu Tsu-Juey , Liao Ying-Chieh , Chiang Cheng-Hung , Hsiao Hsiang-Chiang , Yeh Tung-Chen , Lin Wei-Siang , Lin Wen-Yu , Kuo Jen-Yuan , Hong Chong-Lie , Wu Yih-Je , Li Ying-Siang , Tsai Jui-Peng , Sung Kuo-Tzu , Chang Sheng-Hsiung 
Published: October 2023

We aimed to investigate the sex-related differences in the clinical course of patients with Atrial Fibrillation (AF) enrolled in the Asia–Pacific-Heart-Rhythm-Society Registry. Logistic regression was utilized to investigate the relationship between sex and oral anticoagulant, rhythm control strategies and the 1-year chance to maintain sinus rhythm. Cox-regression was utilized to assess the 1-year risk of all-cause, and cardiovascular death, thromboembolic events, acute coronary syndrome, heart failure, and major bleeding. In the whole cohort (4121 patients, 69 ± 12 years,34.3% female), females had different cardiovascular risk factors, clinical manifestations, and disease perceptions than men, with more advanced age (72 ± 11 vs 67 ± 12 years, p < 0.001) and dyslipidemia (36.7% vs 41.7%, p = 0.002). Coronary artery disease was more prevalent in males (21.1% vs 16.1%, p < 0.001) as well as the use of antiplatelet drugs. Females had a higher use of oral anticoagulant (84.9% vs 81.3%, p = 0.004) but this difference was non-significant after adjustment for confounders. On multivariable analyses, females were less often treated with rhythm control strategies (Odds Ratio [OR] 0.44,95% Confidence Interval [CI] 0.38–0.51) and were less likely to maintain sinus rhythm (OR 0.27, 95% CI 0.22–0.34) compared to males. Cox-regressions analysis showed no sex-related differences for the risk of death, cardiovascular, and bleeding. The clinical management of Asian AF patients should consider several sex-related differences.