Poor Outcomes in Atrial Fibrillation Associated With Greater Gender Disparity

In patients with atrial fibrillation, gender inequality related to social determinants of health is related to adverse outcomes.

Inequalities in gendered social determinants of health are associated with adverse outcomes among patients with atrial fibrillation (AF), according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Researchers assessed the relationship between gendered social determinants of health and adverse outcomes among patients with AF with use of data from the European Society of Cardiology–European Heart Rhythm Association EURObservational Research Programme in AF General Long-Term Registry. Social determinants of health included factors such as education, living alone, smoking, alcohol use, gender inequality index (GII), physical activity, and quality of life measures.

The outcome measure was a composite of major adverse cardiovascular events and all-cause death.

The analysis included 11,096 patients (mean [SD] age, 69.2 [11.4] years; 40.7% women), with a median CHA2DS2-VASc score of 3 (IQR, 2-4). A majority of participants had secondary education, did not live alone, did not smoke or use alcohol, were physically inactive, had a moderate quality of life score, and lived in countries with gender equity.

After adjustment, multivariate analysis showed that higher education (odds ratio [OR], 0.80; 95% CI, 0.66-0.97), not living alone (OR, 0.82; 95% CI, 0.70-0.97), and having at least moderate weekly physical activity (OR, 0.71; 95% CI, 0.60-0.85) were associated with a reduced risk of adverse outcomes.

An increased GII reflecting greater gender inequity was associated with poorer outcomes (OR, 1.18; 95% CI, 1.07-1.30) for each increment of 0.1 in GII. Female patients had a reduced risk (OR, 0.85; 95% CI, 0.73-0.98), although this effect was reversed in countries that had a higher GII (OR, 1.14; 95% CI, 1.00-1.30; Pinteraction = .049).

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Houle J, Proietti M, Azizi Z, et al. Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation. Abstract presented at: ACC 2023; March 4-6, 2023; New Orleans, LA. Abstract 1068-03.