Early rhythm control for AF benefits both sexes
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In patients with atrial fibrillation, compared with usual care, early rhythm control therapy reduced risk for poor outcomes in both sexes, according to new data from the EAST-AFNET 4 trial.
As Healio previously reported, in the main results of EAST-AFNET 4, rhythm control therapy, whether with ablation or antiarrhythmic drugs, within 1 year of AF diagnosis in patients with CV conditions reduced the risk for CV events compared with usual care.
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Sex differences in outcomes
For the present analysis, Isabelle C. Van Gelder, MD, PhD, from the department of cardiology, University of Groningen, University Medical Center Groningen, the Netherlands, and colleagues assessed whether the outcomes of EAST-AFNET 4 differed by sex.
The primary outcome was CV death, stroke or hospitalization for ACS or worsening HF. The primary safety outcome was all-cause death, stroke or prespecified serious adverse events related to complications from rhythm control therapy. Median follow-up was 5.1 years.
The cohort included 1,293 patients (46.4% women). Compared with men, women were older (71 years vs. 70 years; P < .001), were more likely to have sinus rhythm at baseline (58% vs. 51%; P < .001), were less likely to be asymptomatic (25% vs. 36%; P < .001) and had a higher CHA2DS2-VASc score (3.7 vs. 3; P < .001).
The types of early rhythm control therapy did not differ by sex (women, 88% antiarrhythmic drugs and 8.1% ablation; men, 86% antiarrhythmic drugs and 8% ablation; P = .82), and at 2 years, the percentage of women and men from the early group still receiving rhythm control therapy did not differ (P = .903), whereas the percentage of women and men from the usual care group not receiving rhythm control therapy also did not differ (P = .401), according to the researchers.
Benefits in both sexes
For women, the primary outcome occurred in the early group at a rate of 3.4 per 100 patient-years and in the usual care group at a rate of 4.7 per 100 patient-years (HR = 0.72; 95% CI, 0.55-0.93), whereas for men, it occurred in the early group at a rate of 4.3 per 100 patient-years and in the usual care group at a rate of 5.2 per 100 patient-years (HR = 0.83; 95% CI, 0.67-1.03; P for interaction = .408), Van Gelder and colleagues wrote.
The primary safety outcome was comparable in both groups and did not differ by sex (women in early group, 15.8%; women in usual care group, 14.5%; men in early group, 17.2%; men in early group, 17.3%), according to the researchers.
The proportion of patients in sinus rhythm at 2 years was greater in the early group than in the usual care group and did not vary by sex (women, 84.6% vs. 65.2%; men, 80% vs. 56.7%; P for interaction = .746), the researchers wrote.
“A strategy of initiating rhythm control in both women and men with early AF and concomitant cardiovascular conditions was associated with a lower risk of death from cardiovascular causes, stroke, or hospitalization for heart failure or acute coronary syndrome compared with usual care during 5 years of follow-up,” Van Gelder and colleagues wrote. “Safety of early rhythm control was similar between women and men.”
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