Sex Differences in Clinical Characteristics and Management of Non-valvular Atrial Fibrillation in a Resource-Limited Setting

TL;DR

This study finds that men and women with non-valvular atrial fibrillation differ in age, blood pressure, and risk factors in a resource-limited setting.

Contribution

The study identifies sex-specific clinical differences in NVAF management in a resource-limited context.

Findings

Female patients were older and had higher systolic blood pressure and CHA2DS2-VA scores.

Male patients had higher BMI and serum creatinine levels.

Sex-specific risk factors suggest the need for tailored therapeutic strategies.

Abstract

Introduction: Non-valvular atrial fibrillation (NVAF), the most prevalent sustained arrhythmia, significantly increases the risk of complications such as stroke, heart failure, and mortality. Emerging evidence highlights notable sex-related differences in its clinical presentation and management. However, a substantial knowledge gap persists regarding these disparities in resource-limited settings, where data remain scarce and the burden of NVAF is rising.

Objectives: This study aims to assess sex-related differences in clinical characteristics, risk factors, and therapeutic management - specifically anticoagulation use, rate control, and rhythm control strategies - among patients with NVAF.

Methodology: This observational study included patients diagnosed with NVAF from April 2023 to November 2024. Patients were subsequently stratified by sex to evaluate differences in clinical, demographic, and therapeutic variables. Statistical analyses incorporated univariate, bivariate, and multivariate approaches, with statistical significance set at P < 0.05.

Results: A total of 594 patients with NVAF were included, of whom 316 (53.2%) were male and 278 (46.8%) were female. Notably, female patients were generally older (77.8 vs. 75.3 years; P = 0.006), exhibited higher systolic blood pressure (130.1 vs. 124.2 mmHg; P = 0.007), had higher CHA2DS2-VA scores (3.38 vs. 3.1; P = 0.008), and displayed a lower prevalence of heart failure with reduced ejection fraction (15.1% vs. 24.4%; P = 0.005). In contrast, male patients presented a higher body mass index (BMI 26.2 vs. 24.5 kg/m²; P = 0.003) and elevated serum creatinine levels (1.3 vs. 1.09 mg/dL; P < 0.001). In the multivariate analysis, an age ≥75 years (odds ratio [OR] = 1.66; P = 0.026) and systolic blood pressure (OR = 1.01; P = 0.052) were positively associated with female sex, whereas higher BMI (OR = 0.96; P = 0.037) and increased serum creatinine levels (OR = 0.32; P < 0.001) were inversely associated. These findings underscore distinct differences in risk factors and clinical profiles between the sexes.

Conclusions: Female patients frequently present at an advanced age, demonstrate suboptimal blood pressure control, and face an elevated risk of thromboembolism, whereas male patients exhibit a higher BMI and a greater prevalence of heart failure with reduced ejection fraction. These observations underscore the necessity of sex-specific therapeutic strategies.

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