GPs undertreat women with AF

September 1, 2013, European Society of Cardiology

General practitioners (GPs) undertreat women with atrial fibrillation (AF), according to research presented at ESC Congress 2013 today by Dr Pierre Sabouret from France. The analysis of more than 15,000 patients showed that women were undertreated with antithrombotic medications compared to men regardless of their stroke risk and comorbidities.

Dr Sabouret said: "Gender-related differences among outpatients with stable are well known.1-6 Heart diseases are one of the most important causes of death among women worldwide.5 Therefore, it's crucial that women benefit from optimal treatments according to guidelines."

In France both the prevalence (600,000 to 1 million patients) and incidence (110,000 to 230,000 new cases per year) of AF are dramatically increasing.7 ESC AF guidelines recommend the CHA2DS2-VASc score to determine and the need for anticoagulation to prevent stroke.8 Female gender is a specific risk and adds one point to the stroke . However no antithrombotic treatment is required if the patient is female, <65 years old and has lone AF.

Dr Sabouret said: "To improve the cardiovascular prognosis of women with AF it's important to know if there are any in management. Many AF patients are treated by GPs so we studied their practise."

The current study investigated the management of AF patients by GPs in France with a focus on gender differences. The aim was to identify potential factors in the choice of prescription (vitamin K antagonist [VKA] alone, aspirin alone or no oral anticoagulants), particularly patient characteristics, disease characteristics, medical history and concomitant medications.

A total of 15,623 AF patients aged ?18 years were identified from the Longitudinal Patient Database (LPD) during 1 July 2010 to 30 June 2011. The LPD (set up in 1994) contains information on medical history, comorbidities and concomitant medication in 1.6 million active patients from a of 1,200 active GPs in France. The multivariate analyses included 14,274 patients after excluding those on clopidogrel. Median age was 77 years old, 41.6% were women and 93.2% had a CHA2DS2-VASc score >1.

After excluding women ineligible for anticoagulation (CHA2DS2-VASc score of 1 and age <65 years) the researchers found that women were significantly less treated than men. Just 48.1% of women received VKA (vs 52.6% men) (p<0.0001) and 30.5% received no prevention at all (vs 25.4% men) (p<0.0001). More than 21% received only aspirin despite guideline recommendations that they should receive VKA.

Dr Sabouret said: "Women with AF receive less anticoagulation treatment than men despite the fact that they are at greater risk of stroke. The new CHA2DS2-VASc score should be used more stringently, especially in women, to optimise their treatment. Treatment of all women with AF should be reviewed to ensure they are receiving if appropriate according to the CHA2DS2-VASc score."

Age-stratified multivariate analysis* of VKA prescription in patients <75 years found women were half as likely to be treated as men (odds ratio [OR]=0.56, 95% confidence interval [CI]=0.48-0.65) (p<0.0001). In the >75 years subgroup women were 33% less likely to be treated than men (OR=0.67, 95% CI=0.60-0.75) (p<0.0001).

Dr Sabouret concluded: "Women with AF are undertreated compared with men regardless of their stroke risk and comorbidities. This study has revealed a significant gap between guidelines and practice and requires GPs and cardiologists to work together to optimise treatment for women."

Explore further: Innovations in anticoagulation for stroke prevention

Related Stories

Innovations in anticoagulation for stroke prevention

June 13, 2012
New scientific findings in anticoagulation for stroke prevention are paving the way for updates to the European Society of Cardiology (ESC) Guidelines for the management of atrial fibrillation.

Female gender increases stroke risk in AF patients aged over 75 years by 20%

August 27, 2012
Female gender increases the risk of stroke in patients with atrial fibrillation (AF) aged >75 years by 20%, according to a study presented today at the ESC Congress 2012. The findings were presented by Anders Mikkelsen, from ...

Raised risk of ischemic stroke in women with A-fib explored

December 10, 2012
(HealthDay)—Women with atrial fibrillation (AF) have a higher risk of ischemic stroke than men with AF, related in part to differences in the percent time in the therapeutic range (TTR) associated with warfarin anticoagulation ...

Mass screening identifies untreated AF in 5% of 75-76 year olds

September 1, 2013
Stroke is the second cause of death worldwide. Atrial fibrillation is the most common clinically relevant cardiac arrhythmia in Europe, affecting approximately 1.5-2% of the general population.1 Prevalence is estimated to ...

Risk of stroke greater for women than men among older patients diagnosed with atrial fibrillation

May 8, 2012
In a study that examined use of the anticoagulant medication warfarin and risk of stroke following a diagnosis of atrial fibrillation in older patients, women, especially those 75 years or older, had a higher risk of stroke ...

UK doctors still undertreating atrial fibrillation - major risk factor for stroke

October 13, 2011
Despite significant improvements in stroke prevention over the past decade, and a fall in incidence and deaths, UK doctors are still undertreating one of the major risk factors - atrial fibrillation - reveals research published ...

Recommended for you

Researchers borrow from AIDS playbook to tackle rheumatic heart disease

January 22, 2018
Billions of US taxpayer dollars have been invested in Africa over the past 15 years to improve care for millions suffering from the HIV/AIDS epidemic; yet health systems on the continent continue to struggle. What if the ...

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.