Atrial fibrillation and flutter (also known as AFF) is associated with serious health problems and is a significant contributor to death rates. Knowing that, why would there be different death rates for male and female patients who presented with AFF to emergency departments and then discharged? Even 30 and 90 days after discharge. 

AFF is an irregular heartbeat (arrhythmia) that is associated with blood clots to the brain (e.g., stroke) and other organs, heart failure, and sometimes death. It affects approximately 2.66 million Americans. 

The prevalence of AFF increases with age. Rates are 5.9% in men and 2.8% in women 65-69 years of age, increasing to 8.0% in men and 6.7% in women aged 80 years and older. The number of people with AFF is expected to rise substantially in the next ten years, given increased life expectancy.

In a recent study, the investigators examined data from 21,062 patients, 47.5% of whom were women. Male and female patients presented with AFF to emergency departments across Alberta, Canada. They extracted anonymized data from linked provincial databases for all patients who had been discharged from the emergency department after presenting for AFF from 1999 to 2011. The investigators identified differences between male and female patients for times to return to the emergency department, follow-up visit, and death.

Women experienced shorter or longer waits to see a physician and specialist in follow-up, depending on different factors, which were linked to socioeconomic group and the presence of other medical conditions.

Overall, women experienced higher death rates than men at 30 and 90 days after discharge, and this remained significant after adjustment for other demographic and health-related variables. Within 30 days of discharge, 234 patients had died (1.3% female vs 0.9% male). Of these, 6.0%, 6.8%, and 5.6% of deaths were reported as AFF, heart failure, and stroke related, respectively. Within 90 days of discharge, there were 548 deaths (2.9% female vs 2.4% male). Of these deaths, 4.6%, 5.3%, and 4.6% were reported as AFF, heart failure, and stroke related, respectively, and there were more deaths following stroke for woman than men.

Previously, investigators have reported conflicting results regarding AFF care and outcomes between men and women. The differences identified in this study suggest that further examination is required to determine if they are physiological (related to patient factors) or systemic (related to factors such as income, access to services, health care biases, etc.). Mortality and time to death varied based on sex, and this suggests the consequence of these differences is important.

Citation: Rhonda J. Rosychuk, Brian R Holroyd, Xuechen Zhang, Brian H Rowe, Michelle M Graham, “Sex Differences in Outcomes After Discharge from the Emergency Department for Atrial Fibrillation/Flutter,” Canadian Journal of Cardiology   DOI:10.1016/j.cjca.2017.02.002