Rabin Medical Center, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
PLoS One. 2021 Feb 18;16(2):e0247097. doi: 10.1371/journal.pone.0247097. eCollection 2021.
Atrial fibrillation (AF) is a major increasing public health problem worldwide, with clinical and epidemiological differences between men and women. However, contemporary population-level data on incidence and survival are scarce.
To evaluate sex-specific contemporary trends in the incidence, prevalence, and long-term survival of non-valvular AF in a real-world setting.
AF patients diagnosed between 2007-2015, insured by a large, state-mandated health organization in Israel (Maccabi Healthcare Services) were included. AF was diagnosed based on registered diagnoses. Patients with valvular disease, active malignancy, cardiac surgery ≤ 6 months, or recent pregnancy, were excluded. Annual incidence rate, period prevalence, and 5-year survival for each calendar year during the study period, were calculated.
A total of 15,409 eligible patients (8,288 males, 7,121 females) were identified. Males were more likely to be younger, have higher rates of underlying diseases (ischemic heart disease, heart failure, and chronic obstructive pulmonary disease), but with lower rates of hypertension and chronic kidney diseases as compared to female patients. During the study period, age-adjusted incidence decreased both in men: (-0.020/1,000-person year, p-for trend = 0.033) and, women (-0.025/1,000 person-year p = 0.009). The five-year survival rate was significantly higher among men vs. women (77.1% vs. 71.5%, respectively, p<0.001). Age-adjusted prevalence increased significantly among men (+0.102 per year, p-for trend<0.001) yet decreased among women (-0.082 per year, p-for trend = 0.005). A significant trend toward improved long-term survival was observed in women and not in men.
The current study shows significant sex-related disparities in the incidence, prevalence, and survival of AF patients between 2007-2015; while the adjusted incidence of both has decreased over-time, prevalence and mortality decreased significantly only in women.
心房颤动（AF）是全球日益严重的公共卫生问题，男性和女性之间存在临床和流行病学差异。然而，关于发病率和生存率的当代人群数据仍然很少。
评估在现实环境中，非瓣膜性心房颤动的发病率、患病率和长期生存率的性别特异性当代趋势。
纳入 2007 年至 2015 年间被以色列一家大型国家强制健康组织（Maccabi Healthcare Services）承保的心房颤动患者。基于登记的诊断来诊断心房颤动。排除患有瓣膜疾病、活动性恶性肿瘤、心脏手术后 6 个月内或近期怀孕的患者。计算研究期间每个日历年度的年发病率、期间患病率和 5 年生存率。
共确定了 15409 名符合条件的患者（8288 名男性，7121 名女性）。与女性相比，男性更年轻，患有基础疾病（缺血性心脏病、心力衰竭和慢性阻塞性肺疾病）的几率更高，但高血压和慢性肾脏病的发病率较低。在研究期间，男性的年龄调整发病率下降：（-0.020/1000 人年，趋势 p 值=0.033）和女性（-0.025/1000 人年，p=0.009）。男性的五年生存率明显高于女性（分别为 77.1%和 71.5%，p<0.001）。男性的年龄调整患病率显著增加（每年增加 0.102，趋势 p 值<0.001），而女性的患病率则下降（每年减少 0.082，趋势 p 值=0.005）。在女性中观察到长期生存率显著改善的趋势，但在男性中则没有。
本研究显示，2007-2015 年期间，心房颤动患者的发病率、患病率和生存率存在显著的性别差异；尽管随着时间的推移，调整后的发病率有所下降，但只有女性的患病率和死亡率显著下降。
