Sex related differences associated with atrial fibrillation post cardiac surgery

1.In a cohort of adults who underwent cardiac surgery, men were more likely to develop postoperative atrial fibrillation (poAF) than women, but among those women, there was an increased risk of long-term mortality compared to men who developed poAF.

Evidence Rating Level: 2 (Good) 

Women are at a higher risk of postoperative complications and mortality after open heart surgery compared to men. However, it is unclear if there is an association between sex and postoperative atrial fibrillation (poAF), the most common complication after cardiac surgery. To address this gap in knowledge, this retrospective cohort study enrolled adults over 20 years of age who underwent a coronary artery bypass graft (CABG), an open aortic valve replacement or repair (AVR), open mitral valve replacement or repair (MVR), or combined procedures, with the use of cardiopulmonary bypass (CPB). The study measured the incidence of poAF, and all-cause mortality as the primary outcomes. PoAF was defined as any atrial fibrillation that occurred on an electrocardiogram (EKG) during the hospitalization in patients who originally presented with a normal sinus rhythm. A total of 21,568 patients (14,967 were men (69.4%) and 6,601 (30.6%) were women) participated in the study. Of these individuals, 8,499 (39.4%) developed poAF after open heart surgery, and women had a higher incidence of poAF compared to men (2694 [40.8%] vs 5805 [38.8%], however, according to the multivariable logistics regression model, women had a lower risk of poAF (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; P<.001). In women who developed poAF, there was a higher mortality rate compared to women who did not develop poAF (HR, 1.31; 95% CI, 1.21-1.42, P<.001). The same pattern applied to men (HR, 1.17; 95% CI, 1.11-1.25, P<.001), however, this difference was not as extreme. The findings indicate that men had a higher incidence of poAF, however, women who developed poAF were at a higher risk for mortality. The study was limited since only patients who underwent a CABG, AVR, MVR, or combined procedures were included, thus making it difficult to generalize the results to patients who underwent other procedures. Overall, in this retrospective cohort study of patients undergoing cardiac surgery, women had a lower risk of developing poAF compared to men, but the women who developed poAF had a higher risk of mortality.

Click to read the study in JAMA Network Open

Image: PD

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