Laboratory of Cardiovascular Prevention, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy.
Department of Neuroscience, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy.
Intern Emerg Med. 2020 Mar;15(2):231-240. doi: 10.1007/s11739-019-02134-z. Epub 2019 Jun 26.
To analyze sex-related differences about AF prevalence, use of OAC and outcomes focusing on the older age classes. We used administrative data of the Lombardy Region, describing period prevalence, use of OAC and outcomes from 2002 to 2014 for all patients diagnosed with AF. AF prevalence over the 2002-2014 period was higher in males than in females (2.7% vs. 2.1%, p < 0.001), increasing with age. From 2003 to 2014, not treated AF patients decreased mostly in males (from 40.3 to 33.7% with respect to 43.7-39.8% in females). Age-stratified adjusted logistic regression analysis found that females were more likely treated with OAC when < 65 years in 2003 (OR 1.51, 95% CI 1.35-1.69) and in 2014 (OR 1.32, 95% CI 1.13-1.53); contrariwise, were less likely treated with OAC when age ≥ 75 years, in 2003 (OR 0.92, 95% CI 0.86-0.98) and in 2014 (OR 0.77, 95% CI 0.72-0.81).Adjusted Cox regression analysis confirmed that female AF patients had a higher risk of stroke (HR 1.18, 95% CI 1.14-1.21) and a lower risk of major bleeding (HR 0.83, 95% CI 0.80-0.86), while, had a lower risk for all-cause death (HR 0.82, 95% CI 0.80-0.83). AF prevalence was higher in male than in female patients, while thromboembolic risk was higher in female. Older female patients were under-treated with OAC particularly in recent years. Over long-term follow-up, female had a higher risk of stroke and a lower risk of major bleeding and all-cause death.
分析 AF 患病率、OAC 使用和结局方面的性别差异，重点关注老年人群。我们使用了伦巴第大区的行政数据，描述了 2002 年至 2014 年期间所有被诊断为 AF 的患者的时期患病率、OAC 使用和结局。2002-2014 年期间，男性的 AF 患病率高于女性（2.7%比 2.1%，p<0.001），且随年龄增长而增加。2003 年至 2014 年期间，未接受治疗的 AF 患者数量主要减少了男性（与女性相比，从 40.3%降至 33.7%）。分层调整后的逻辑回归分析发现，2003 年时，年龄<65 岁的女性更有可能接受 OAC 治疗（OR 1.51，95%CI 1.35-1.69），2014 年时（OR 1.32，95%CI 1.13-1.53）也是如此；相反，年龄≥75 岁的女性接受 OAC 治疗的可能性较小，2003 年时（OR 0.92，95%CI 0.86-0.98）和 2014 年时（OR 0.77，95%CI 0.72-0.81）也是如此。调整后的 Cox 回归分析证实，女性 AF 患者发生卒中的风险更高（HR 1.18，95%CI 1.14-1.21），大出血风险更低（HR 0.83，95%CI 0.80-0.86），而全因死亡风险更低（HR 0.82，95%CI 0.80-0.83）。男性患者的 AF 患病率高于女性，而女性的血栓栓塞风险更高。年龄较大的女性患者 OAC 治疗不足，尤其是近年来。长期随访中，女性发生卒中的风险更高，大出血和全因死亡的风险更低。
