title: Sex differences in the relationship between amiodarone use and the need for permanent pacing in patients with atrial fibrillation. Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. The Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. Women hospitalized with atrial fibrillation: gender differences, trends and outcome from a 20-year registry in a Middle Eastern country (1991-2010). Gender-related differences in catheter ablation of atrial fibrillation. Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation: The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study Anticoagulation in women with non-valvular atrial fibrillation in the stroke prevention using an oral thrombin inhibitor (SPORTIF) trials. Cycling of inducibility of paroxysmal supraventricular tachycardia in women and its implications for timing of electrophysiologic procedures. Efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation in women. Impact of atrial fibrillation on mortality, stroke, and medical costs. Risk of proarrhythmic events in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: a multivariate analysis. Gender differences in stroke risk of atrial fibrillation patients on oral anticoagulant treatment. Quality of life improves with treatment in the Canadian Trial of Atrial Fibrillation. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community Impact of gender on the prognosis of patients with nonvalvular atrial fibrillation. Apixaban versus warfarin in patients with atrial fibrillation. Age and gender influences on rate and duration of paroxysmal atrial fibrillation.
abstract: BACKGROUND Amiodarone use was associated with an increased need for pacemaker insertion in a retrospective study of patients with atrial fibrillation ( AF ) and prior myocardial infa rct ion . The aims of this study were to determine prospect ively whether amiodarone increases the need for pacemakers in a general population of patients with AF and whether this effect is modified by sex . METHODS The study included 1005 patients with new-onset AF who were enrolled in the Fibrillation Registry Assessing Costs , Therapies , Adverse events , and Lifestyle ( FRACTAL ) .  Multivariable Cox regression models , including time-dependent covariates accounting for medication exposure , were used to evaluate the risk of pacemaker insertion associated with amiodarone use . RESULTS Amiodarone use was associated with an increased risk of pacemaker insertion ( hazard ratio [ HR ] , 2.01 ; 95 % confidence interval [ CI ] , 1.08 - 3.76 ) after adjustment for age , sex , atrial flutter , coronary artery disease , heart failure , and hypertension . The effect of amiodarone use was modified by sex , with a significant risk in women but not in men ( HR , 4.69 ; 95 % CI , 1.99 - 11.05 vs HR , 1.05 ; 95 % CI , 0.42 - 2.58 [ P = .02 ] ) . This interaction remained significant after adjustment for weight , body mass index , weight-adjusted amiodarone dose , and use of other antiarrhythmic or rate control drugs . CONCLUSION The risk of bradyarrhythmia requiring pacemaker insertion associated with amiodarone use for AF is significantly greater in women than in men , independent of weight or body mass index Patients with atrial fibrillation ( AF ) report impaired health-related quality of life ( QOL ) . Differences between men and women with AF have not been described and personality attributes such as somatization ( tendency to amplify benign bodily sensations ) may mediate potential gender differences in QOL . Patients with AF ( n = 264 , 59 % men ) who participated in the Canadian Trial of Atrial Fibrillation ( n = 403 ) completed vali date d QOL question naires at baseline , 3 months , and 12 months after antiarrhythmic drug treatment .  Women were significantly older than men and a greater proportion had hypertension , but other cardiac variables did not differ between women and men . At baseline , after controlling for significant clinical and demographic factors , women reported worse physical health ( p = 0.002 ) and functional capacity ( p < 0.001 ) , but not mental health or general well-being . Women also had more frequent and severe cardiac symptoms than men ( both p < 0.001 ) . Physical health improved significantly from baseline to 3 months for women ( p = 0.002 ) , but not for men ( p = 0.066 ) . Conversely , mental health improved for men ( p = 0.007 ) , but not for women . Cardiac symptom frequency and severity improved over time for women and men ( all p < 0.001 ) . Tendency to somatize predicted poor QOL , and women had higher scores than men ( p = 0.023 ) . However , after controlling for somatization , women still had worse physical function , functional capacity , and symptom burden than men . Independent of cardiac disease severity and age , women with AF had significantly more impaired QOL than men , specifically on domains related to physical rather than emotional functioning . Personality attributes may have a role in influencing QOL outcomes BACKGROUND AND PURPOSE Nonvalvular atrial fibrillation ( AF ) is a strong , independent risk factor for stroke , but the absolute rate of stroke varies widely among AF patients , importantly influencing the potential benefit of antithrombotic prophylaxis . We explore factors associated with ischemic stroke in AF patients taking aspirin .  METHODS We performed multivariate logistic regression analysis of 2012 participants given aspirin alone or in combination with low , inefficacious doses of warfarin in the Stroke Prevention in Atrial Fibrillation I-III trials followed for a mean of 2.0 years , during which 130 ischemic strokes were observed . RESULTS Age ( relative risk [RR]=1.8 per decade , P<0.001 ) , female sex ( RR=1.6 , P=0.01 ) , history of hypertension ( RR=2.0 , P<0.001 ) , systolic blood pressure > 160 mm Hg ( RR=2.3 , P<0.001 ) , and prior stroke or transient ischemic attack ( RR=2.9 , P<0.001 ) were independently associated with increased stroke risk . Regular consumption of > /=14 alcohol-containing drinks per week was associated with reduced stroke risk ( adjusted RR=0.4 , P=0.04 ) . Among SPAF III participants , estrogen hormone replacement therapy was associated with a higher risk of ischemic stroke ( adjusted RR=3.2 , P=0.007 ) . With the use of these variables , a risk stratification scheme for primary prevention separated participants into those with high ( 7.1%/y , 22 % of the cohort ) , moderate ( 2.6%/y , 37 % of the cohort ) , and low ( 0.9%/y , 41 % of the cohort ) rates of stroke . Ischemic strokes in low-risk participants were less often disabling ( P<0.001 ) . CONCLUSIONS Patients with AF who have high and low rates of stroke during treatment with  aspirin can be identified . However , validation of our risk stratification scheme is necessary before it can be applied with confidence to clinical management . Postmenopausal estrogen replacement therapy and moderate alcohol consumption may additionally modify the risk of stroke in AF , but these findings require confirmation BACKGROUND Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use . Dabigatran is a new oral direct thrombin inhibitor . METHODS In this noninferiority trial , we r and omly assigned 18,113 patients who had atrial fibrillation and a risk of stroke to receive , in a blinded fashion , fixed doses of dabigatran--110 mg or 150 mg twice daily -- or , in an unblinded fashion , adjusted-dose warfarin . The median duration of the follow-up period was 2.0 years . The primary outcome was stroke or systemic embolism . RESULTS Rates of the primary outcome were 1.69 % per year in the warfarin group , as compared with 1.53 % per year in the group that received 110 mg of dabigatran ( relative risk with dabigatran , 0.91 ; 95 % confidence interval [ CI ] , 0.74 to 1.11 ; P<0.001 for noninferiority ) and 1.11 % per year in the group that received 150 mg of dabigatran ( relative risk , 0.66 ; 95 % CI , 0.53 to 0.82 ; P<0.001 for superiority ) . The rate of major bleeding was 3.36 % per year in the warfarin group , as compared with 2.71 % per year in the group receiving 110 mg of dabigatran ( P=0.003 ) and 3.11 % per year in the group receiving 150 mg of dabigatran ( P=0.31 ) . The rate of hemorrhagic stroke was 0.38 % per year in the warfarin group , as compared with 0.12 % per year with 110 mg of dabigatran ( P<0.001 ) and 0.10 % per year with 150 mg of dabigatran ( P<0.001 ) . The mortality rate was 4.13 % per year in the warfarin group , as compared with 3.75 % per year with 110 mg of dabigatran ( P=0.13 ) and 3.64 % per year with 150 mg of dabigatran ( P=0.051 ) . CONCLUSIONS In patients with atrial fibrillation , dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin , as well as lower rates of major hemorrhage .  Dabigatran administered at a dose of 150 mg , as compared with warfarin , was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage . ( Clinical Trials.gov number , NCT00262600 . BACKGROUND Most of the published research on atrial fibrillation ( AF ) is limited to studies in the developed world and included mainly Caucasian patients . Data about women with AF among other ethnicities is very limited . OBJECTIVES The aim of this study was to compare the clinical characteristics , treatment and outcome of women to men hospitalized with AF in a middle-eastern country . METHODS Retrospective analysis of prospect i ve registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made . Clinical characteristics , management , and outcomes of AF patients were compared according to gender . RESULTS During the 20-years period ; 1417 women and 2432 men were hospitalized for AF . Women were 5 years older and more likely to have diabetes mellitus , hypertension , and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men . There was no gender preference in the use of anticoagulation . The prevalence of concomitant ischemic heart disease and hypertension increased , while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period . In-hospital mortality and stroke rates were comparable between the two groups . CONCLUSIONS Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas , mortality and stroke rates were comparable AIMS Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men . A catheter-based strategy is therefore widely attractive , but the impact of gender on catheter ablation ( CA ) of AF remains undefined . METHODS AND RESULTS We included 221 consecutive patients ( 150 men ) who underwent CA of drug-refractory AF .  Gender differences in clinical presentation and outcomes were compared . Women were older ( P = 0.002 ) , had a longer history of AF ( P = 0.04 ) , and were more likely to have hypertension ( P = 0.04 ) . Moreover , a concomitant valvular heart disease tended to be more common in women ( 32.4 vs. 23.3 % ; P = 0.28 ) and left atrium dimensions were significantly larger ( P = 0.003 ) . However , acute success rate and complications rate were similar between genders . After 22.5 + /- 11.8 months of follow-up , the overall freedom from arrhythmia recurrences was similar ( 83.1 vs. 82.7 % in men ) , and a similar improvement in SF-36 quality of life scores was achieved in both groups . CONCLUSION Women are referred for AF ablation later with a more complex clinical pre-operative presentation . Despite this higher risk profile in women , no differences were detected in clinical outcomes . Our findings indicate that CA of AF appears to be safe and effective in women as in men Background —Previous studies provide conflicting results about whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation ( AF ) . We examined data from a large contemporary cohort of AF patients to address this question . Methods and Results —We prospect ively studied 13 559 adults with AF and recorded data on patients ’ clinical characteristics and the occurrence of incident hospitalizations for ischemic stroke , peripheral embolism , and major hemorrhagic events through search ing vali date d computerized data bases and medical record review . We compared event rates by patient sex using multivariable log-linear regression , adjusting for clinical risk factors for stroke , and stratifying by warfarin use . We identified 394  ischemic stroke and peripheral embolic events during 15 494 person-years of follow-up off warfarin . After multivariable analysis , women had higher annual rates of thromboembolism off warfarin than did men ( 3.5 % versus 1.8 % ; adjusted rate ratio [ RR ] , 1.6 ; 95 % CI , 1.3 to 1.9 ) . There was no significant difference by sex in 30-day mortality after thromboembolism ( 23 % for both ) . Warfarin use was associated with significantly lower adjusted thromboembolism rates for both women and men ( RR , 0.4 ; 95 % CI , 0.3 to 0.5 ; and RR , 0.6 ; 95 % CI , 0.5 to 0.8 , respectively ) , with similar annual rates of major hemorrhage ( 1.0 % and 1.1 % , respectively ) . Conclusions —Women are at higher risk than men for AF-related thromboembolism off warfarin . Warfarin therapy appears be as effective in women , if not more so , than in men , with similar rates of major hemorrhage . Female sex is an independent risk factor for thromboembolism and should influence the decision to use anticoagulant therapy in persons with AF AIMS The risk of stroke is greater among women with atrial fibrillation ( AF ) than men .  Warfarin protects against stroke , but treatment-related bleeding occurs more often in women than in men . METHODS AND RESULTS SPORTIF III ( open label , n=3410 ) and V ( double-blind , n=3922 ) included 2257 women with AF and one or more stroke risk factors r and omized to warfarin [ target international normalized ratio ( INR ) 2.0 - 3.0 ] or ximelagatran ( 36 mg twice daily ) . Primary outcomes were all stroke ( ischaemic/haemorrhagic ) and systemic embolic event .  Women were older , on average , than men , 73.4+/-8.0 vs. 69.8+/-9.0 years ( P<0.0001 ) . More women were > 75-years old and women had more risk factors than men had ( P<0.0001 ) . The INR on warfarin ( mean 2.5+/-0.7 ) was within target range for 67 % of follow-up regardless of gender . Women more often developed primary events [ 2.08%/year , 95 % confidence interval ( CI ) 1.60 - 2.56%/year vs. 1.44%/year , 95 % CI 1.18 - 1.71%/year in men ; P=0.016 ) . Major bleeding rates were similar ( P=0.766 ) but women experienced more overall ( major/minor ) bleeding ( P<0.001 ) . Warfarin was associated with more overall bleeding in both genders and more major bleeding in women than in men ( P=0.001 ) . CONCLUSION When compared with men with AF , women in these studies were older and had more stroke risk factors . Women were more prone to anticoagulant-related bleeding ; the higher rate of thrombo-embolism among women was related to more frequent interruption of anticoagulant therapy Arrhythmias in women may be affected by phases of the menstrual cycle . This study was design ed to determine the prevalence of perimenstrual clustering of spontaneous episodes of paroxysmal supraventricular tachycardia ( SVT ) in women . It also tested the hypothesis that women with this temporal pattern of events have an altered probability of induction of paroxysmal SVT during electrophysiologic testing at higher estrogen states ( midcycle or with estrogen replacement therapy ) than at low estrogen states ( perimenstrual or without estrogen replacement ) . A structured history of the relation of spontaneous paroxysmal SVTs to phases of the menstrual cycle was obtained prospect ively among 42 women referred during a 3-year period . Patients with cyclical patterns of spontaneous tachycardias , who had had negative electrophysiologic studies at midcycle or while receiving estrogen replacement therapy  , had repeat procedures ( 1 ) when premenstrual or at the onset of menses , or ( 2 ) after stopping estrogen replacement therapy . Seventeen of 42 consecutive female patients ( 40 % ) had histories of perimenstrual clustering of arrhythmias . Six women ( 4 with normal menstrual cycles , 2 on estrogen replacement therapy )  , who qualified for paired electrophysiologic studies because of a negative initial electrophysiologic study that included provocation with isoproterenol , had inducibility into SVTs during the second study . All 6 had dual atrioventricular ( AV ) nodal pathway physiology , 4 had AV nodal reentrant tachycardia ( AVNRT ) induced , 1 had both AVNRT and reciprocating AV tachycardias , and 1 had nonsustained AVNRT and an atrial tachycardia induced . Successful ablation procedures were performed in 5 of the 6 patients . Thus , among women with a history of perimenstrual clustering of paroxysmal SVT and among those receiving estrogen replacement therapy , scheduling of elective electrophysiologic procedures at times of low estrogen levels ( premenstrual or off estrogen replacement therapy ) may facilitate the probability of a successful procedure OBJECTIVES It is uncertain whether gender affects the outcomes of catheter ablation ( CA ) for atrial fibrillation ( AF ) . The objective of the study is to evaluate the efficacy and safety of CA for long-st and ing persistent AF in women . METHODS Between January 2010 and May 2011 , 220 consecutive patients ( 73 females , 33.2 % ) , with long-st and ing persistent AF who underwent CA were prospect ively recruited . Gender-related differences in clinical presentation , periprocedural complications , and outcomes were compared . RESULTS Women were less likely to have lone AF than men ( 27.4 % vs 47.6 % ; P = 0.004 ) . The incidence of rheumatic heart disease was higher in women ( 19.2 % in women vs 1.4 % in men ; P < 0.001 ) . Women had a lower initial ablation success rate than men ( 35.6 % vs 57.1 % ; P = 0.003 ) . Hematomas occurred more often in women ( 6.8 % in women vs 0.7 % in men ; P = 0.027 ) . A Cox regression analysis demonstrated total duration of AF ( per month , hazard ratio [ HR ] 1.003 , confidence interval [ CI ] 1.001 - 1.006 ; P = 0.006 ) and gender ( HR 1.663 , CI 1.114 - 2.485 ; P = 0.013 ) as the independent predictors for recurrence after the first CA . CONCLUSIONS Women and long AF duration were closely related to the recurrence of AF after the first ablation in patients with long-st and ing persistent AF . Women also had a higher risk of vascular complications BACKGROUND The impact of  atrial fibrillation ( AF ) on mortality , stroke , and medical costs is unknown . METHODS We conducted a prospect i ve cohort study of hospitalized Medicare patients with AF and 1 other cardiovascular diagnosis ( CVD ) compared with a matched group without AF ( n = 26,753 ) , r and omly selected in 6 age-sex strata from 1989 MedPAR files of more than 1 million patients diagnosed as having AF .  Stroke rates were also determined in another cohort free of CVD ( n = 14,267 ) .  Total medical costs after hospitalization were available from a 1991 cohort . Cumulative mortality , stroke rates , and costs following index admission were adjusted by multivariate and proportional hazard regression analyses . RESULTS Mortality rates were high in individuals with CVD , ranging from 19.0 % to 52.1 % in 1 year . Adjusted relative mortality risk was approximately 20 % higher in patients with AF in all age-sex strata during each of the 3 years studied ( P < .05 ) . Incidence of stroke was high in individuals with CVD , 6.2 % to 15.4 % in 1 year , with and without AF , and was at least 5-fold higher than in individuals without CVD . In those with CVD , stroke rates were approximately 25 % higher in women with AF ( P < .05 ) but only 10 % higher in men . Adjusted total Medicare spending in 1 year was 8.6- to 22.6-fold greater in men , and 9.8- to 11.2-fold greater in women with AF ( P < .05 ) . Second- and third-year costs were increased as well . CONCLUSION Prevention of AF and treatment of patients with AF and associated CVD may yield benefits in reduced mortality and stroke as well as reducing health care costs OBJECTIVES This study examined the risk of proarrhythmic events in patients receiving antiarrhythmic drugs for treatment of atrial fibrillation ( AF ) according to present-day safety guidelines . BACKGROUND Advances in underst and ing the proarrhythmic risk of antiarrhythmic drugs has led to development of safety guidelines for these agents . Such guidelines were used in the Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study . METHODS This study was an analysis of the risk of arrhythmic events ( arrhythmic death , resuscitated cardiac arrest , sustained ventricular tachycardia ( VT ) , and torsade de pointes VT ) in the antiarrhythmic drug arm of the AFFIRM study . Each time an antiarrhythmic drug was begun , it was counted as an exposure to that drug and the risk of an arrhythmic event was calculated . RESULTS A total of 2,033 patients received 3,030 exposures to antiarrhythmic drugs . Ninety-six arrhythmic events occurred by six years . Patients with a left ventricular ejection fraction < 40 % had more arrhythmic events . Twelve documented cases of torsade de pointes VT were noted . The incidence of torsade de pointes was 0.6 % at five years ( 95 % confidence interval 0.32 to 1.07 ) . CONCLUSIONS The overall risk of adverse arrhythmic events upon exposure to antiarrhythmic drugs in the AFFIRM study was reasonably low . Strict criteria for the safe use of antiarrhythmic drugs were successful in minimizing proarrhythmic events The efficacy of adjusted-dose oral anticoagulant treatment ( OAT ) in the prevention of stroke in atrial fibrillation ( AF ) is well documented . Available data show that AF patients are widely heterogeneous in terms of ischaemic stroke risk . The role of female gender as a predictor of stroke risk is inconsistent , in particular it is unclear if warfarin treatment is able to prevent stroke equally in both sexes . We performed a prospect i ve study on 780 AF patients on OAT , followed by an Anticoagulation Clinic , to evaluate if female gender is a risk factor for stroke among patients on OAT  and if the quality of anticoagulation is different between genders . No difference was found in relation to the quality of anticoagulation between genders ( p=0.5 ) . During follow-up 33 patients had major bleedings ( rate 1.37 x 100 pt/yrs ) but no difference was found between genders in bleeding risk . Forty patients had ischaemic events [ rate 1.66 x 100 pt/yrs ; males rate 1.2 x 100 pt/yrs ; females rate 2.43 x 100 pt/yrs ; p=0.042 ; relative risk ( RR ) of females vs. males 2.0 ( 95 % confidence interval [ CI ] 1.3 - 3.1 ) ; p= 0.004 ] . The higher rate of ischaemic events in females with respect to males was confirmed at Cox regression analysis after correction for age ( p=0.009 ) . In addition , strokes occurring in females were more disabling , and RR for severe and fatal stroke , defined according to Modified Rankin scale , of females vs. males was 3.1 ( 95 % CI 1.3 - 6.5 ; p=0.001 ) . In conclusion , our data show a higher risk of stroke in anticoagulated AF females with respect to males , despite a similar quality of anticoagulation BACKGROUND The impact of atrial fibrillation ( AF ) and its treatment on health-related quality of life ( QOL ) is not well understood . We assessed QOL in patients with symptomatic AF participating in the Canadian Trial of Atrial Fibrillation . METHODS Self-report QOL question naires including the Short-Form-36 ( SF-36 ) , symptom checklist ( SCL ) and AF Severity Scale ( AFSS ) were completed at baseline and 3 , and 12 months after r and omization . RESULTS The study group was aged 65 + /- 10 years and 59 % were male . By design , 50 % of patients were r and omized to amiodarone ( n = 132 ) , 25 % to sotalol ( n = 66 ) , and 25 % to propafenone ( n = 66 ) . Most patients had normal left ventricular function ( 89 % ) .  Physical ( 41.9 + /- 9.3 to 43.7 + /- 9.2 , P = .001 ) and mental health ( 47.5 + /- 10.5 to 49.0 + /- 9.8 , P = .023 ) summary measures from the SF-36 improved significantly from baseline to 3 months . Arrhythmia symptom frequency and severity ( SCL ) also improved markedly from baseline to 3 months ( symptom frequency 20.4 + /- 9.4 to 16.2 + /- 9.5 and symptom severity 16.7 + /- 8.2 to 12.9 + /- 7.4 , both P < .001 ) . QOL improvements were not significantly different among the groups r and omized to amiodarone , sotalol , or propafenone . However , patients with no symptomatic recurrences of AF had higher scores at 3 months on measures of global well-being than those with recurrences in the first 3 months ( 7.4 + /- 1.8 vs 6.9 + /- 1.8 , P < .05 ) . There were no significant QOL changes from the 3 to 12 month assessment . CONCLUSION In patients with symptomatic AF , QOL improves after treatment , independent of the specific drug used for treatment . This is especially true for patients in whom treatment prevents AF recurrence CONTEXT Prior risk stratification schemes for atrial fibrillation ( AF ) have been based on r and omized trial cohorts or Medicare administrative data bases , have included patients with established AF , and have focused on stroke as the principal outcome . OBJECTIVE To derive risk scores for stroke alone and stroke or death in community-based individuals with new-onset AF . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve , community-based , observational cohort in Framingham , Mass. We identified 868 participants with new-onset AF , 705 of whom were not treated with warfarin at baseline . Risk scores for stroke ( ischemic or hemorrhagic ) and stroke or death were developed with censoring when warfarin initiation occurred during follow-up . Event rates were examined in low-risk individuals , as defined by the risk score and 4 previously published risk schemes . MAIN OUTCOME MEASURES Stroke and the combination of stroke or death . RESULTS During a mean follow-up of 4.0 years free of warfarin use , stroke alone occurred in 83 participants and stroke or death occurred in 382 participants . A risk score for stroke was derived that included the following risk predictors : advancing age , female sex , increasing systolic blood pressure , prior stroke or transient ischemic attack , and diabetes . With the risk score , 14.3 % of the cohort had a predicted 5-year stroke rate < or = 7.5 % ( average annual rate < or = 1.5 % ) , and 30.6 % of the cohort had a predicted 5-year stroke rate < or = 10 % ( average annual rate < or = 2 % ) . Actual stroke rates in these low-risk groups were 1.1 and 1.5 per 100 person-years , respectively . Previous risk schemes classified 6.4 % to 17.3 % of subjects as low risk , with actual stroke rates of 0.9 to 2.3 per 100 person-years . A risk score for stroke or death is also presented . CONCLUSION These risk scores can be used to estimate the absolute risk of an adverse event in individuals with AF , which may be helpful in counseling patients and making treatment decisions BACKGROUND Anticoagulants are effective in the prevention of stroke in atrial fibrillation and flutter ( AF ) . We aim ed to find out the prevalence of AF in the UK and to estimate the proportion of patients with AF who might benefit from anticoagulation . METHODS We screened with electrocardiography a r and om sample of 4843 people from the community aged 65 years and older for AF . Participants with AF had further investigations to identify risk factors for stroke and contraindications to anticoagulants . We used three sets of criteria to assess risk and eligibility for anticoagulation . FINDINGS 228 ( 4.7 % ) participants had AF . According to analyses derived from risk stratifications based on the Stroke Prevention in Atrial Fibrillation ( SPAF ) study 61 % of these patients would have benefited from anticoagulation , 49 % according to pooled analysis of trial results , and 41 % according to the inclusion criteria for the SPAF 3 study .  Anticoagulants  were used by 1114 ( 23 % ) of all patients and were least used among elderly women , who may be the most likely to benefit . Echocardiography would be useful to assess the need for anticoagulation only in patients younger than 75 years with no contraindications to treatment and no clinical risk factors for stroke . INTERPRETATION Anticoagulants seem to be underused and misdirected in treatment of AF , according to various criteria . Efforts to promote and support wider and more appropriate use of anticoagulants would seem to be justified , and should decrease the incidence of stroke amongst elderly patients Treatment guidelines for atrial fibrillation ( AF ) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF ( NVAF ) . The present study aim ed to determine the impact of gender on prognosis of Japanese patients with NVAF . A sub analysis of 7,406 patients with NVAF ( mean age 70 years ) who were followed-up prospect ively for 2 years was performed using data from the J-RHYTHM registry . The primary end points were thromboembolic events , major hemorrhaging , total mortality , and cardiovascular mortality . Compared with male subjects ( n = 5,241 ) , female subjects ( n = 2,165 ) were older and displayed greater prevalences of paroxysmal AF , heart failure , and hypertension but less prevalences of diabetes , previous cerebral infa rct ion , and coronary artery disease . Male and female patients had mean CHADS2 ( Congestive heart failure , Hypertension , Age of 75 years or more , Diabetes mellitus and prior Stroke or transient ischemic attack ) scores of 1.6 and 1.8 , respectively ( p < 0.001 ) . Warfarin was given to 87 % of male patients and 86 % of female patients ( p = 0.760 ) , and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline ( 1.91 vs 1.90 , respectively , p = 0.756 ) . Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging ( odds ratio 1.59 , 95 % confidence interval 1.05 to 2.40 , p = 0.027 ) and all-cause mortality ( odds ratio 1.78 , 95 % confidence interval 1.25 to 2.55 , p < 0.002 ) but not for thromboembolic events ( odds ratio 1.24 , 95 % confidence interval 0.83 to 1.86 , p = 0.297 ) or cardiovascular mortality ( odds ratio 0.96 , 95 % confidence interval 0.56 to 1.66 , p = 0.893 ) . In conclusion , female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin . However , male gender is a risk factor for major hemorrhaging and all-cause mortality BACKGROUND Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations . Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin . METHODS In this r and omized , double-blind trial , we compared apixaban ( at a dose of 5 mg twice daily ) with warfarin ( target international normalized ratio , 2.0 to 3.0 ) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke . The primary outcome was ischemic or hemorrhagic stroke or systemic embolism . The trial was design ed to test for noninferiority , with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause . RESULTS The median duration of follow-up was 1.8 years . The rate of the primary outcome was 1.27 % per year in the apixaban group , as compared with 1.60 % per year in the warfarin group ( hazard ratio with apixaban , 0.79 ; 95 % confidence interval [ CI ] , 0.66 to 0.95 ; P<0.001 for noninferiority ; P=0.01 for superiority ) . The rate of major bleeding was 2.13 % per year in the apixaban group , as compared with 3.09 % per year in the warfarin group ( hazard ratio , 0.69 ; 95 % CI , 0.60 to 0.80 ; P<0.001 ) , and the rates of death from any cause were 3.52 % and 3.94 % , respectively ( hazard ratio , 0.89 ; 95 % CI , 0.80 to 0.99 ; P=0.047 ) . The rate of hemorrhagic stroke was 0.24 % per year in the apixaban group , as compared with 0.47 % per year in the warfarin group ( hazard ratio , 0.51 ; 95 % CI , 0.35 to 0.75 ; P<0.001 ) , and the rate of ischemic or uncertain type of stroke was 0.97 % per year in the apixaban group and 1.05 % per year in the warfarin group ( hazard ratio , 0.92 ; 95 % CI , 0.74 to 1.13 ; P=0.42 ) . CONCLUSIONS In patients with atrial fibrillation , apixaban was superior to warfarin in preventing stroke or systemic embolism , caused less bleeding , and result ed in lower mortality . ( Funded by Bristol-Myers Squibb and Pfizer ; ARISTOTLE Clinical Trials.gov number , NCT00412984 . ) UNLABELLED The influence of age and gender on the character of paroxysmal atrial fibrillation ( PAD ) has not been described . METHODS The heart rate ( HR ) during  PAF in patients receiving placebo or antiarrhythmic therapy  was analyzed . Data from 177 24-hour Holter recordings  were analyzed to mark the onset and termination of PAF and converted into RR interval files . PAF episodes lasting at least 2 minutes and containing < or = 20 % noise were included . HR during the first 30-second segment versus during the remainder of the episode , and the duration of PAF episodes were compared among groups of different ages and sex ( Wilcoxon test ) . RESULTS 236 episodes from 55 recordings in 32 patients ( all patients : 61.4 + /- 12.8 years ; men ( 19 ) : 58.5 + /- 12.6 years ; women ( 13 ) 65.5 + /- 12.4 years , P = ns for difference in age ) fulfilled the inclusion criteria . Women had a higher mean heart rate at AF onset ( 123 + /- 35 beats/min vs 115 + /- 20 beats/min , P = 0.02 ) and during the remainder of the episode ( 120 + /- 25 beats/min vs 112 + /- 22 beats/min at the start , P = 0.01 , and 116 + /- 26 beats/min vs 108 + /- 18 beats/min subsequently , P = 0.01 ) . Episodes tended to be longer in women ( mean 89.8 min vs 50.5 min , P = NS ) and in the aged ( mean 83.8 min vs 46.9 min , P = NS ) . CONCLUSION PAF episodes are associated with faster heart rates and last longer in women , which may reflect differing autonomic responses to AF . A slower ventricular rate during PAF in older patients probably reflects an increasing prevalence of impaired atrioventricular conduction
target: In brief , female atrial fibrillation patients more commonly present comorbidities , leading to a higher prevalence of persistent atrial fibrillation ; moreover , they refer to hospital care later and with a longer disease history .
  Atrial fibrillation symptoms relate to low quality of life in female patients ; in fact , atrial fibrillation paroxysm usually presents higher heart rate , leading to preferentially adopt a rate rather than a rhythm-control strategy .
  Female atrial fibrillation patients present an increased risk of stroke , worsened by the lower  oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile .
  Trans-catheter ablation is under-used in female patients and , on the contrary , they are more commonly affected by anti-arrhythmic drug side effects
background: Atrial fibrillation is the most common supraventricular arrhythmia .
  Its prevalence increases with age and preferentially affects male patients .
  Over 75 years of age , however , female patients being more prevalent , the absolute number of patients affected is similar between sexes .
  Despite this , few data are available in the literature concerning sex-related differences in atrial fibrillation patients .
  The present systematic review therefore considers comorbidities , referring symptoms , quality of life , pharmacological approaches  and  trans-catheter ablation  in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome .