The gender difference in risk factor and incidence rate of hospitalization for heart failure in Japanese atrial fibrillation patients: The Fushimi AF Registry

Abstract

Abstract Background Gender-specific medicine is of concern in cardiovascular medicine. However, the gender difference in risk factor and incidence rate of hospitalization for heart failure (HF) in Japanese atrial fibrillation (AF) patients is little known. The aim of this study is to compare the risk factor and incidence rate of HF hospitalization in male and female. Method In the Fushimi AF Registry, we started to enroll patients from March 2011, and follow-up data were available for 4,496 patients by the end of February 2022. In the entire cohort, 2,677 were male and 1,819 were female. We compared clinical characteristics and risk factor and incidence rate of HF hospitalization between the two groups. Result Male patients were younger (male vs, female; 71.5 years vs. 76.7 years, p<0.001), greater in body weight (65.0 kg vs. 51.2 kg, p<0.001), had lower pulse rate (77.5 bpm vs. 79.4 bpm, p=0.008), more often persistent/permanent type (52.0% vs. 48.2%, p=0.044), more likely to have previous stroke/systemic embolism (21.1% vs. 18.6%, p=0.039), diabetes mellitus (DM) (26.2% vs. 19.9%, p<0.001), coronary artery disease (CAD) (16.0% vs. 12.3%, p<0.001) and less likely to have prior HF (24.0% vs. 32.3%, p<0.001), chronic kidney disease (CKD) (33.7% vs. 39.3%, p<0.001) and had lower CHADS2 score (1.96 vs. 2.15, p<0.001). In prescription data, male patients more often received oral anticoagulant (58.2% vs. 52.1%, p<0.001) and less in diuretics. Systolic blood pressure, hypertension, prescription of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta blocker were comparable between the two groups. During the median follow-up of 1,824 days, the incidence rate of HF hospitalization was lower in male than female group (male vs. female: 1.74 vs. 2.09 per 100 person-years, log rank p=0.005). On multivariate Cox regression analysis, age, sustained type of AF, prior HF, DM, CAD and CKD were significantly associated with an increased risk of HF hospitalization in male group. On the other hand, age, prior HF, DM, CKD were significantly associated with an increased risk of HF hospitalization but neither sustained type of AF nor CAD was in female group. Conclusion The incidence rate of HF hospitalization was lower in male patients than female patients. The risk factor associated with HF hospitalization were different between male and female in Japanese AF patients.