Postoperative atrial fibrillation more common in men, but mortality worse in women
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Key takeaways:
- Men were more likely than women to develop atrial fibrillation after cardiac surgery.
- However, among patients with postoperative atrial fibrillation, the mortality risk was higher in women than in men.
Among patients who had cardiac surgery, men were more likely than women to have postoperative atrial fibrillation, but for those with postoperative AF, the mortality risk was greater in women, researchers reported.
“While [postoperative] AF is the most common complication after open-heart surgery, its relationship with sex — particularly regarding long-term survival — has been underexplored,” Sergey Karamnov, MD, a cardiothoracic anesthesiologist in the department of anesthesiology, perioperative and pain medicine at Brigham and Women’s Hospital, told Healio. “By investigating this association, we aim to inform future sex-specific treatment strategies.”
The researchers conducted a retrospective cohort study with data from 21,568 patients (mean age, 67 years; 31% women) without prior AF who underwent cardiac surgery — CABG, aortic valve surgery, mitral valve surgery or a combined procedure with cardiopulmonary bypass — at two centers from 2002 to Oct. 1, 2016, for whom data existed on postoperative AF status. The primary outcomes were postoperative AF, defined as any AF detected on ECG during the index hospitalization, and all-cause mortality. Patients were followed until Dec. 1, 2022.
Among the cohort, 40.8% of women and 38.8% of men developed postoperative AF, but after adjustment for patient- and surgery-related risk factors, women were less likely than men to have postoperative AF (adjusted OR = 0.85; 95% CI, 0.79-0.91; P < .001), Karamnov and colleagues wrote.
However, the magnitude of elevated mortality risk associated with postoperative AF was greater in women (HR = 1.31; 95% CI, 1.21-1.41) than in men (HR = 1.17; 95% CI, 1.11-1.25; P for interaction = .02), the researchers found.
“We anticipated that women who developed [postoperative] AF would face a significantly higher risk of long-term mortality compared to men, given existing evidence suggesting sex-based differences in cardiovascular outcomes,” Karamnov told Healio. “However, it was striking that despite women having a lower overall incidence of [postoperative] AF, those who did develop this condition had a disproportionately higher mortality risk. This finding highlights the need for a deeper understanding of not only how sex influences the development and consequences of [postoperative] AF after cardiac surgery but also why women tend to have higher mortality rates in general following these procedures.”
To reduce the incidence of postoperative AF in women, researchers need to identify sex-specific risk factors; implement early risk stratification and provide personalized prophylactic interventions for high-risk patients; and develop sex-specific management strategies that address preoperative, intraoperative and postoperative care, he said in an interview.
“To better treat women who develop [postoperative] AF, it is crucial to recognize that they may be at higher risk for adverse long-term outcomes compared to men. This calls for heightened surveillance and potentially more careful management in women, both during the perioperative period and after discharge,” Karamnov told Healio. “Personalized treatment plans that address the specific risk factors in women, as well as close monitoring of their cardiac status postoperatively, including home-wearing devices, may help mitigate the long-term mortality risk.”
For more information:
Sergey Karamnov, MD, can be reached at skaramnov@bwh.harvard.edu.
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