Silva Raisa L, Guhl Emily N, Althouse Andrew D, Herbert Brandon, Sharbaugh Michael, Essien Utibe R, Hausmann Leslie R M, Magnani Jared W
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US.
Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, US.
Am J Prev Cardiol. 2021 Sep 3;8:100252. doi: 10.1016/j.ajpc.2021.100252. eCollection 2021 Dec.
Women have worse patient-reported outcomes in atrial fibrillation (AF) than men, but the reasons remain poorly understood. We investigated how comorbid conditions, treatment, social factors, and their modification by sex would attenuate sex-specific differences in patient-reported outcomes in AF.
In a cohort with prevalent AF we measured patient-reported outcomes with the Short-Form-12 (SF-12, an 8-domain quality of life measure), and the AF Effect on QualiTy of Life (AFEQT), an instrument specific to AF, both with range 0-100 and higher scores indicating superior outcomes. We examined sex-specific differences in patient-reported outcomes in multivariable-adjusted regression analyses incorporating demographics, comorbid conditions, treatment, social factors, and their sex-based modification.
In 339 individuals (age 72±10, 45% women), women (vs. men) reported worse physical functioning on the SF-12 (49.7±39.0 versus 65.0±34.0), social functioning (69.8±31.8 versus 79.7±25.8), and mental health (67.4±20.2 versus 75.0±18.6). These differences were attenuated with adjustment for comorbid conditions and depression. Women had worse composite AFEQT scores (73.8±18.4 versus 78.5±16.6) and symptoms and treatment scores than men with differences remaining significant after multivariable adjustment. There were not significant interactions by sex and the array of covariates when examining differences in patient-reported outcomes between women and men.
We identified sex-specific differences in patient-reported outcomes assessed with general and AF-specific measures. Compared to men, women with AF reported worse overall health-related quality of life, even after consideration of both relevant covariates and their modification by sex. Our research indicates the importance of consideration of sex-based inequities when evaluating patient-reported outcomes in AF.
在心房颤动（AF）患者中，女性报告的患者结局比男性更差，但原因仍知之甚少。我们研究了合并症、治疗、社会因素及其性别差异如何减弱AF患者报告结局中的性别特异性差异。
在一个患有AF的队列中，我们使用简短健康调查问卷12项量表（SF-12，一种8领域生活质量测量工具）和AF生活质量影响量表（AFEQT，一种特定于AF的工具）来测量患者报告的结局，二者范围均为0-100，分数越高表明结局越好。我们在多变量调整回归分析中检查了患者报告结局的性别特异性差异，该分析纳入了人口统计学、合并症、治疗、社会因素及其基于性别的差异。
在339名个体（年龄72±10岁，45%为女性）中，女性（与男性相比）在SF-12上的身体功能（49.7±39.0对65.0±34.0）、社会功能（69.8±31.8对79.7±25.8）和心理健康（67.4±20.2对75.0±18.6）报告较差。通过对合并症和抑郁症进行调整，这些差异有所减弱。女性的AFEQT综合评分（73.8±18.4对78.5±16.6）以及症状和治疗评分比男性差，多变量调整后差异仍然显著。在检查男女患者报告结局差异时，性别与一系列协变量之间没有显著的相互作用。
我们确定了使用通用和特定于AF的测量方法评估的患者报告结局中的性别特异性差异。与男性相比，AF女性报告的总体健康相关生活质量更差，即使在考虑了相关协变量及其性别差异之后也是如此。我们的研究表明，在评估AF患者报告结局时考虑基于性别的不平等的重要性。
