AF ablation improves quality of life vs. drug therapy in both sexes; disparity not reduced
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Despite atrial fibrillation ablation conferring greater quality of life benefits vs. drug therapy in the CABANA trial, sex-based differences in quality of life persisted, according to a new analysis from the trial.
“Women with AF generally report worse quality of life compared with men, with more AF symptoms and more associated functional impairment. The causes of these differences remain uncertain,” Emily P. Zeitler, MD, MHS, cardiologist at Dartmouth Health and assistant professor of medicine at Dartmouth Institute in Lebanon, New Hampshire, and colleagues wrote. “The present report provides a comprehensive description of the effects of ablation versus drug therapy on quality of life outcomes by sex in CABANA.”
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The CABANA trial enrolled 2,204 patients from 110 sites with AF eligible for ablation already on at least two rate- or rhythm-control drugs.
As Healio previously reported, in patients with AF, catheter ablation conferred better outcomes compared with drug therapy in on-treatment and per-protocol analyses, but not in an intention-to-treat analysis.
Researchers periodically assessed Atrial Fibrillation Effect on Quality of Life (AFEQT) summary and component scores and Mayo AF-Specific Symptom Inventory (MAFSI) frequency score over 60 months. These data were used to evaluate sex-based differences in outcomes among patients who received ablation compared with drug therapy.
Zeitler and colleagues reported that women had lower mean baseline AFEQT score compared with men (55.9 vs. 65.6).
Patients who underwent AF ablation experienced greater improvement in AFEQT score compared with those who underwent drug therapy, with a similar treatment effect observed by sex (12-month mean adjusted difference in women, 6.1 points; 95% CI, 3.5-8.6; 12-month mean adjusted difference in men, 4.9 points; 95% CI, 3-6.9).
Participants with AFEQT scores of less than 70 points at baseline had more improvement in AFEQT compared with those with higher baseline scores, with a mean 12-month difference of 7.6 points for women (95% CI, 4.3-10.9) and 6.4 points for men (95% CI, 3.3-9.4), according to the study.
In addition, mean 12-month difference in MAFSI frequency score among patients assigned to ablation compared with drug therapy was 2.5 for women (95% CI, 3.4 to 1.6) and 1.3 for men (95% CI, 2 to 0.6).
“The observation that women and men with AF differ in quality of life outcomes builds on > 20 years of clinical investigations into AF sex-related differences in presentation, treatment and outcomes. One of the challenges involved in comparing AF outcomes by sex comes from the many ways in which the cohorts differ, both in standard baseline characteristics as well as in more subtle aspects of their AF phenotype,” the researchers wrote. “In light of this well-established observation of lower quality of life among women with AF and the superiority of ablation over other rhythm control strategies at suppressing AF, it remains unclear why women are less likely to undergo AF ablation despite similar lifetime prevalence of AF in men and women.”
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