Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Gender-related Differences in Management of Nonvalvular Atrial Fibrillation in an Asian Population

  • Lee, Jung Myung (Division of Cardiology, Kyung Hee University Medical College) ;
  • Kim, Tae-Hoon (Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine) ;
  • Cha, Myung-Jin (Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Junbeom (Department of Cardiology, College of Medicine, Ewha Womans University) ;
  • Park, Jin-Kyu (Division of Cardiology, Hanyang University Medical Center) ;
  • Kang, Ki-Woon (Division of Cardiology, Eulji University Hospital) ;
  • Shim, Jaemin (Division of Cardiology, Korea University Anam Hospital) ;
  • Uhm, Jae-Sun (Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine) ;
  • Kim, Jun (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Park, Hyung Wook (Department of Cardiovascular Medicine, Chonnam National University Medical School) ;
  • Lee, Young Soo (Division of Cardiology, Catholic University of Daegu) ;
  • Choi, Eue-Keun (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Chang-Soo (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Joung, Boyoung (Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine) ;
  • Kim, Jin-Bae (Division of Cardiology, Kyung Hee University Medical College)
  • Received : 2017.12.26
  • Accepted : 2018.03.07
  • Published : 2018.06.30
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Abstract

Background and Objectives: Gender-related differences in health care utilization for atrial fibrillation (AF) are increasingly recognized. However, large cohort data for examining gender-related differences in AF are lacking in Asian populations. Methods: The Registry for Comparison Study of Drugs for Symptom Control and Complication Prevention of AF (CODE-AF Registry) is a prospective observational cohort-study that enrolled participants at 10 tertiary hospitals in South Korea. Baseline characteristics retrieved from the CODE-AF Registry were analyzed. Results: A total of 6,274 patients were recruited (mean age $67{\pm}11years$, mean $CHA_2DS_2-VASc$ score $2.7{\pm}1.7$, 63% male, 65% paroxysmal AF) from June 2016 to April 2017. Women underwent less electric cardioversion (12.3% vs. 19.6%, p<0.001), less radiofrequency ablation (12.4% vs. 17.9%, p<0.001), and less antiarrhythmic drug therapy (44.7% vs. 49.5%, p<0.001), despite having more severe symptoms (symptom class III or IV, 45.8% vs. 37.5%, p<0.001). Among patients with a $CHA_2DS_2-VA$ score of 2 or more, a slightly higher proportion of women were taking oral anticoagulants than men (85.7% vs. 81.9%, p=0.002), and non-vitamin K antagonist oral anticoagulant (NOAC) use was more prevalent in women than men (70.4% vs. 62.3%, p<0.001). Insufficient NOAC dosing was very common, more so in women than men (61.5% vs. 56.3%, p<0.001). Conclusions: Female patients with AF were treated more conservatively and rhythm control strategies were used less frequently than in males, even though the female patients with AF had more severe symptoms. While insufficient NOAC dosing was common in both sex, it was significantly more frequent in women.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF), Ministry of Health & Welfare

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