Gender Matters: Why Afib Is More Fatal for Women

Volume 13 - Issue 3 - March 2013
Posted on: 3/4/13
0 Comments
954 reads

Start Page:
34
End page:
37
Author(s):

Mellanie True Hills, Speaker and CEO, StopAfib.org, Decatur, Texas

In recent years, there have been many revelations about heart disease and how it specifically affects women. Research has shown that women frequently have different symptoms of a heart attack than men, and women are often worse off after a heart attack.1

Not surprisingly, the diagnosis, symptoms, and treatments of atrial fibrillation (afib) can differ for women, too. One stark, potentially deadly difference: in women 20 to 79 years old, the risk of stroke is 4.6-fold greater in women than men.2 In addition, mortality for women with afib is up to 2.5 times greater than that for men.3

Afib affected approximately 2.66 million people in the United States in 2010, according to the U.S. Centers for Disease Control. And the numbers will only climb. With the aging Baby Boomer population, estimates from the Centers for Disease Control indicate that afib will affect 12 million people by 2050.4 Afib sufferers have a five-fold increase in stroke risk compared to the general population. The numbers for women tell a dire story:

Each year, in the United States, about 55,000 more women than men have strokes.5
Stroke is the fourth leading cause of death for women.5
Women account for more than 60 percent of stroke-related deaths.5
After age 75, which is the median age for afib onset, 60 percent of those with afib are women.5
Afib risk in women increases over men when patients have other conditions, such as diabetes mellitus, congestive heart failure, hypertension, valvular disease, and myocardial ischemia.6
There have been greater declines in stroke death rates among men than in women.6

We celebrate the differences between men and women, but as far as afib and stroke are concerned, the differences can be deadly. Women are also more likely to experience longer symptomatic episodes, more frequent recurrences, and significantly higher ventricular rates during afib.7 Interestingly, women with type B blood have a 17 percent increase in stroke risk compared to men.8

Like the revelations about women and heart disease, these differences may surprise many healthcare providers. The differences also extend to how women afib patients are viewed by some healthcare providers. Too many times, women with afib symptoms are dismissed as having panic attacks or being stressed and not taken seriously. However, afib in women can be much more serious. When healthcare providers know about the differences in risk, diagnosis, and treatment, they can provide the best possible treatment to female afib sufferers.
Assessing Stroke and Bleeding Risk

To assess the stroke risk of those with afib and the need for anticoagulants, many healthcare providers use the CHADS2 and CHA2DS2-VASc scoring tools (Figure 2) to help gauge the risk of stroke and determine whether to prescribe anticoagulants. However, the CHADS2 tool fails to consider womens apparent greater stroke risk.

For those who have a CHADS2 score of 0 or 1, meaning that anticoagulants may not be deemed necessary, considering their CHA2DS2-VASc score may provide a more accurate assessment of their true stroke risk. It incorporates vascular disease, another age range (65 to 74 years), an additional weighting for being 75 years or older, and the female gender.9 Therefore, using only the CHADS2 tool for women (and some men) who are a CHADS2 score of 0 or 1 could be a disservice to them.

When deciding whether to use anticoagulants, some healthcare providers also weigh bleeding risk. One commonly used tool that helps gauge this risk is the HAS-BLED scoring tool that takes into account major bleeding risk factors, such as Hypertension, Abnormal kidney or liver function, Stroke, Bleeding, Labile INR (unstable or high INRs, or poor time in the therapeutic range), Elderly, and Drugs or alcohol. For more information about the HAS-BLED scoring tool, see Figure 3.10 Using these tools can help optimize afib patient care.
Potential Misperceptions About Women and Afib

Healthcare providers have to be careful about afib-related misperceptions and clarify them for patients. Some media reported that a recent Danish study concluded that females with atrial fibrillation werent at greater risk of a stroke. These news outlets didnt read the full study, because the authors clearly stated that for there to be no additional stroke risk, women must be younger than 65 and have no other stroke risk factors aside from afib. In other words, they must truly have lone afib.

The study authors noted that the European Society of Cardiology (ESC) guidelines (Figure 4) advise that female patients with afib take oral anticoagulants, except those who meet the age