Caracterización epidemiológica del estudio REFLEJA: estrategias de prevención del ictus en mujeres con fibrilación auricular

Abstract

Introduction and objectivesEvaluation of differences in stroke prevention strategies in women in a prospective atrial fibrillation (AF) cohort. MethodsThe REFLEJA study included all outpatients with AF evaluated between October 2017 and October 2018 from a Spanish tertiary hospital center. The use and type of oral anticoagulation (OAC) and rhythm control strategies were analyzed. ResultsOf the 1499 patients included (age 73.8±11.1 years), 48.1% were women, having a higher CHA2DS2-VASc than men (2.90±1.62 vs 4.11±1.34; P<.001), and a similar use of antiarrhythmics (9.8 vs 12.2%; P=.15), although there was a lower indication for electrical cardioversion (8.6 vs 2.5%; P<.001) and catheter ablation (3.3 vs 1.5%; P=.036). The use of OAC was higher in women (91 vs 95.3%; P=.002) although less with direct anticoagulants (DOAC)(67.1 vs 60.1%; P=.012) and without differences in the use of reduced doses (13.2 vs 20%; P=.065). Previous stroke, previous electrical cardioversion, CHA2DS2-VASc ≥ 2, and de novo AF were predictors of greater use of DOAC, while chronic kidney disease, high bleeding risk (HAS-BLED ≥ 3), or moderate-severe non-rheumatic valvular heart disease were associated with a lower prescription. ConclusionsThe female population of the REFLEJA study presented a more unfavorable clinical profile than that of the men, with less rhythm control, although female sex was not independently associated with less use of OACs or NOAC.