Added: Wafa Babcock - Date: 29.07.2021 20:42 - Views: 44035 - Clicks: 3929
Atrial fibrillation AF is a major increasing public health problem worldwide, with clinical and epidemiological differences between men and women. However, contemporary population-level data on incidence and survival are scarce. To evaluate sex-specific contemporary trends in the incidence, prevalence, and long-term survival of non-valvular AF in a real-world setting. AF patients diagnosed between —, insured by a large, state-mandated health organization in Israel Maccabi Healthcare Services were included.
AF was diagnosed based on registered diagnoses. Annual incidence rate, period prevalence, and 5-year survival for each calendar year during the study period, were calculated. A total of 15, eligible patients 8, males, 7, females were identified. Males were more likely to be younger, have higher rates of underlying diseases ischemic heart disease, heart failure, and chronic obstructive pulmonary diseasebut with lower rates of hypertension and chronic kidney diseases as compared to female patients.
During the study period, age-adjusted incidence decreased both in men: The five-year survival rate was ificantly higher among men vs. A ificant trend toward improved long-term survival was observed in women and not in men. The current study shows ificant sex-related disparities in the incidence, prevalence, and survival of AF patients between —; while the adjusted incidence of both has decreased over-time, prevalence and mortality decreased ificantly only in women.
This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The study data included individual-level sensitive information. Queries regarding the data can be addressed to study reference : Maccabi Institute for Health Services Research. Sharbat house, 8th floor, Tel Aviv, Israel : contact maccabitech.
Funding: The study was sponsored by Pfizer Pharmaceuticals Israel ltd. Shiyovich received a honorarium from Pfizer Pharmaceuticals Israel ltd. Tirosh is an employee of Pfizer Israel. The remaining authors declare no conflict of interest. The funder approved the study protocol and approved the publication of the study and the manuscript. Competing interests: A. Shiyovich received an honorarium consultation fees from Pfizer Pharmaceuticals Israel ltd.
Atrial fibrillation AF is the most frequent cardiac arrhythmia of clinical ificance, with ificantly greater prevalence in older persons and those with cardiovascular risk factors and co-morbidities [ 12 ]. AF is considered a major public health problem associated with increased risk of thromboembolism and stroke [ 134 ], chronic kidney disease, dementia, acute myocardial infarction, heart failure, and mortality [ 5 — 9 ].
The most ificant predictors of AF are age and sex; the prevalence of AF doubles with every decade and is fold greater in men compared with women [ 11 — 13 ]. Recent reports from different countries demonstrated a trend of increase in the incidence and prevalence of AF over time while mortality seems to be decreasing [ 5714 — 19 ]. Furthermore, it has been suggested that these temporal changes are disproportionate between the sexes and different age groups [ 51920 ]. However, these reports are based mostly on registries and cohort studies and thus might be biased while data from unselected populations are sparse.
The aim of this study was to evaluate sex-specific contemporary trends in the incidence, prevalence and long-term survival of AF patients in a real-world setting. The current study included patients insured by Maccabi Healthcare Services MHSone of the largest healthcare providers in Israel, covering over 2 million members, diagnosed with AF between andand aged 21 years or older at the time of diagnosis. The date of AF diagnosis was defined as the index date.
Exclusion criteria were—1. Patient consent was waived by the review board. Baseline comorbidities and risk score calculations were obtained from MHS patient registries, described ly [ 2122 ] and included: age, sex, socioeconomic status SESsmoking status, hypertension, diabetes mellitus, peripheral vascular disease PVDischemic heart disease IHD with or without a history of myocardial infarction MIcongestive heart failure CHFchronic obstructive pulmonary disease COPDstroke or transient ischemic attack TIA.
Data regarding medical therapy at least 2 dispensed packs during days before index date were obtained and classified according to the following therapeutic agents: angiotensin-converting enzyme inhibitors ACE-iangiotensin receptor blockers ARBsalpha-blockers, beta-blockers, calcium channel blockers, digoxin, diuretics, heparins, nitrates, antiplatelets, and vasodilators.
Residential area SES level was based on a commercial index developed by Points Location Intelligence ranging from 1 lowest to 10 highest. Scoring is conducted according to various socioeconomic indices e. Comparisons between sexes were conducted using the Mann-Whitney test or Chi-square test for continuous and categorical variables, respectively. Prevalent AF cases were defined as MHS members alive at the beginning of an index year and before or throughout that year.
Kaplan-Meier analysis was performed to study the differences in all-cause mortality survival from the index date. We employed a log-linear regression model to estimate annual percentage change, in which age and calendar year included as independent variables. For survival analysis, patients were classified into 3 groups according to the diagnosis period; —, Women looking for sex Petah tiqwa bc, and — Throughout the follow-up period, a total of 15, subjects 8, males, 7, females were diagnosed with AF.
S1 Table presents the of incident AF cases by year and sex. Table 1 displays the baseline characteristics of the incident cases stratified by sex. Male patients The prevalence of chronic medical therapy with antiplatelet medications was ificantly higher among males; however; treatment with angiotensin-receptor blockers, beta-blockers, diuretics, and calcium channel blockers was statistically ificantly less common compared with females. The incidence of AF increased with age. Moreover, the incidence seemed to be higher in males compared with females across all age groups Fig 1S2 Table.
Furthermore, the crude incidence increased over time from 1. The age-adjusted temporal trends in incidence are presented in Fig 2. A statistically ificant decrease in the age-adjusted incidence was observed over time Thus, this measure adjusts for differences in incidence stemming for differences in age distributions. The total of subjects diagnosed with AF increased from 14, 7, males, 6, females in to 22, in 12, males, 9, females. Fig 3 and S3 and S4 Tables present the of subjects with AF stratified by sex and follow-up year and the prevalence of AF by age and sex, respectively.
The prevalence of AF increased from The prevalence of AF increased with age and seemed to be higher in Women looking for sex Petah tiqwa bc compared with females and higher in vs. A greater increase in the prevalence of AF was observed among males Long term survival curves following AF diagnosis by sex are presented in S1 Fig. The five-year survival rate with AF was ificantly higher among males compared to females Fig 5 presents sex-specific long-term survival curves, stratified by the period of diagnosis.
As displayed in Fig 5a statistically ificant trend of improvement in survival was found among females but not males, throughout the study period. The present study evaluated temporal trends in the incidence and prevalence of AF by age and sex in contemporary real-world population data obtained from a large healthcare provider in Israel.
The main findings include the following: 1 the incidence of AF is higher in men versus women and increased over time in both sexes; however, the age-adjusted incidence decreased in both sexes. This could be attributed to the higher scoring of female sex and older age among females rather than other comorbidities and risk factors in women.
The latter increase was more pronounced among males compared with females. However, the age-adjusted analysis showed an increase in prevalence among males and a decrease among females over time. Our findings are consistent with most other reports demonstrating a higher incidence of AF up to 2-fold among men compared with women and a disproportionate increase in incidence with increasing age among both sexes [ 1213172425 ].
The incidence rates and the observed sex-related disparities in the characteristics of incident AF patients, particularly the older age, greater prevalence of hypertension, and the lower prevalence of IHD among females, are overall consistent with rates reported from other developed countries [ 1726 — 28 ].
Several studies have evaluated temporal trends in the sex-specific incidence and AF, most showing findings consistent with ours [ 12131829 ]. The Framingham Heart Study and a global systematic review reported an increase in the incidence of AF in Women looking for sex Petah tiqwa bc sexes between — and —, respectively. However, recent studies have suggested plateauing and flattening of the trend of an increase in the incidence of AF [ 29 — 32 ], which are in partial agreement and possibly precede our findings of the age-adjusted decrease in the incidence of AF.
Our observation is novel and ificant, for which a clear explanation is unknown. Moreover, it has been ly reported that the population attributable risk for AF of coronary disease is higher in men, whereas the population attributable risks of elevated systolic blood pressure and valvular disease are higher in women [ 1934 ]. Hence, different trends in the incidence and management of such risk factors could result in sex-related disparities in the incidence of AF.
Similar to incidence, the prevalence of AF was ificantly greater in men compared with women. This finding is consistent with reports from other countries, although AF prevalence has been shown to differ ificantly according to ancestry [ 1718 ]. Contemporary studies evaluating sex-specific temporal trends in AF prevalence are relatively scarce. Two studies from the UK, based on primary care settings, showed an increase in AF prevalence in both sexes across all ages. Similar findings also reported in a year follow-up from the Framingham cohort and a community-based study from Iceland [ 1318 ].
Our age-adjusted prevalence trends showed an increase among men and a decline in women. Such sex-related disparities are in agreement with findings from the Copenhagen City Heart Study [ 37 ]. Hence, ourwhich are based on a relatively contemporary cohort, could be one of the first indications supporting the notion that prevalence is indeed leveling off. Two main determinants of AF prevalence, which can explain the observed trends, are the incidence of AF and improved survival. With the incidence plateauing, the increased survival and aging of the patients could be more prominent explanations for the elevated unadjusted prevalence.
Moreover, earlier diagnosis i. Numerous sex-specific factors could for the differences in the incidence, prevalence, and temporal trends of AF between men and women.
First, sex differences in risk factors, comorbidities, higher frequency of atypical presentation, and deferred diagnosis among women versus men [ 132638 ]. Second, hormonal increased estrogen, cyclical progesterone, and increased prevalence of thyroid abnormalities in women and differences in cardiac electrophysiological parameters e. Third, structural differences between men and women. For example, smaller left atria and ventricles, lower left ventricular wall thickness, and a higher degree of atrial fibrosis in women vs.
Fourth, metabolic differences could also play a role, with women reported having higher serum values of FGF and inflammatory markers such as C-reactive protein level [ 264345 ]. Fifth, sex-related differences in AF management, with a lower rate of pharmacological antiarrhythmic and anticoagulants medications or interventional rhythm control electric cardioversion, or catheter ablation among women compared with men [ 262846 ].
Lastly, increased rate of complications such as stroke and thromboembolism and mortality among women [ 2646 ]. The explanations for the differences in temporal trends are not completely clear and are probably multifactorial, relating to differences in survival, risk factors, management, and diagnosis. We found higher mortality rates among women compared with men; however, survival improved ificantly only among women throughout the study period. The finding of higher mortality rates among women is consistent with a report from the Framingham Heart Study [ 47 ] and a large meta-analysis that included over 4 million patients [ 48 ].
Possible explanations of this finding include increased comorbidity, delayed AF diagnosis with a longer AF history, and a higher AF burden among women.
Another plausible explanation is undertreatment, with multiple reports indicating a reduced rate of oral anticoagulants prescription, increased utilization of rate control over rhythm control strategy, and lower referral to invasive strategies e. studies have demonstrated a trend for improved survival in AF over time, as shown in our investigation among females [ 132529 ].Women looking for sex Petah tiqwa bc
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Sex-specific contemporary trends in incidence, prevalence and survival of patients with non-valvular atrial fibrillation: A long-term real-world data analysis