Women With Atrial Fibrillation Face Rougher Road Than Men

Sept. 24 (HealthDay News) -- Women with atrial fibrillation are significantly more likely to have a stroke or die than are men with the heart condition, a new study has found.

Despite this, the study suggests, women with the condition receive less medical attention than men.

Atrial fibrillation occurs when the two small upper chambers of the heart, the atria, quiver rather than beat effectively. This can lead to pooling and clotting of blood. If a clot travels from the atria to an artery in the brain, it can cause a stroke.

Rush University Medical Center researchers reviewed past studies and medical literature and found that women with atrial fibrillation are more likely than men to experience symptomatic attacks and have recurrences, and that women have significantly higher heart rates during atrial fibrillation, which increases the risk for stroke.

"Stroke is one of the most devastating results of cardiovascular disease, and atrial fibrillation increases the risk of stroke," the lead investigator, Dr. Annabelle Volgman, medical director of the Heart Center for Women at Rush University Medical Center, said in a news release from the hospital. "Women are at higher risk of atrial fibrillation-related stroke than men and are more likely to live with stroke-related disability, which can significantly lower quality of life."

Volgman and her fellow researchers reviewed 20 years of studies that examined gender differences in atrial fibrillation and "were able to determine the most rational, safe and effective gender-specific approach to therapy for women."

For starters, prevention therapies should be emphasized, the researchers said, as should treatments to ensure safe management once the condition is diagnosed.

Their findings and recommendations related to gender differences included:

• Women are not prescribed blood thinners as often as men, resulting in a higher incidence of the formation of clots that break loose and block other vessels. The risk/benefit ratio should be assessed individually for each woman.
• Women have a greater risk of bleeding from anticoagulation therapy, so this treatment must be monitored carefully.
• Closely monitor women being treated with antiarrhythmic drugs because they have a higher risk for life-threatening arrhythmias and slow heart rates requiring permanent pacing.
• Women's hormonal fluctuations can cause more life-threatening arrhythmias.
• Monitor women's potassium levels in the blood because they have a higher risk of low levels, which boost the risk for drug-related arrhythmias.
• Because women have a higher sensitivity to such therapies as statins and vasodilators, liver and kidney function should be closely watched.
• Women are referred less often or later for non-drug treatments such as pacemaker implantation or ablation. Ablative therapy should remain an option for symptomatic women because they have success rates similar to those of men.

The study also found that, in general, women with atrial fibrillation have a lower quality of life than men with the disease. But the researchers said that careful assessment and relief of symptoms, and adequate control of heart rate or rhythm can make things better.

"For women with atrial fibrillation, these gender differences should always be kept in mind to help prevent strokes and heart failure and improve their quality of life," Volgman said.

The study is published in the September issue of Gender Medicine.

SOURCE: Rush University Medical Center, news release, Sept. 22, 2009