P837Gender related differences in management of nonvalvular atrial fibrillation: analysis of multicenter registry (An observational prospective cohort for COmparision study of Drugs for symptom control an

Abstract

Background: Sex-specific differences in health-care utilization and treatment of atrial fibrillation (AF) are increasingly recognized. However, a large cohort data examining sex-specific differences of AF in Asian population has been lacking. Methods: The Registry for COmparision study of Drugs for symptom control and complication prEvention of AF (CODE-AF registry) is a prospective observational cohort study for the comparison of drugs for rate control, rhythm control and anticoagulation therapy for stroke prevention of AF patients, enrolling up to 20,000 patients in 10 tertiary hospitals in South Korea. The baseline characteristics of the CODE-AF registry were analyzed to examine the sex-specific differences. Results: The CODE-AF Study recruitment commenced in June 2016, and recruited 4521patients (mean age 68 ±10 years, mean CHA2DS2-VASc score 2.7±1.6, 62% male, 74% paroxysmal AF) from June 2016 to December 2016. The prescribing rate of oral anticoagulant (OAC) was 72%, which consists of warfarin (20%) and NOACs (52%). Female patients showed higher proportion of having permanent pacemaker implant (9.3% vs. 4.4%, p<0.001), and dyslipidemia (36.7% vs. 30.6%). Female patients had more severe AF related symptom than male patients (EHRA III or IV: 45.6% vs. 39.0%, p<0.001). Use of warfarin (18.9% vs. 21.2%, p=0.077) and dabigatran (15.8% vs. 14.7%, p=0.361) werenot different significantly between female and male patients. Rivaroxaban (16.4% vs. 12.2%, p<0.001), apixaban (25.5% vs. 17.0%, p<0.001), and edoxaban (5.3% vs. 3.1%, p=0.001) usage were more frequent in females than males. Women underwent less electric cardioversion (14.4% vs. 21.4%, p<0.001), and less radiofrequency ablation (13.5% vs. 19.3%, p<0.001). The frequency of total antiarrhythmic drug usage showed no significant gender differences. However, amiodarone (7.8% vs. 11.3%, p<0.001) and sotalol (0.5% vs. 1.3%, p=0.014) were used less in women than men. Anticoagulation status was examined according to 2016' European Society of Cardiology guideline. In patients with CHA2DS2-VA score of 0 (except point in sex category), anticoagulation status was not different between both gender groups. However, in patients with CHA2DS2-VA score of 1, the proportion of patients taking NOAC was prominently higher in women than men (Dabigatran 12.6% vs. 7.7%, p=0.028, Rivaroxaban 11.6% vs 5.1%, p=0.001, Apixaban 20.7% vs. 4.2%, p<0.001, Edoxaban 6.8% vs. 2.1%, p=0.01). This may be due to national insurance policy of Korea that using CHA2DS2-VASc score of ≥2 for insurance coverage criteria for NOAC. Conclusions: Female patients with atrial fibrillation were treated more conservatively with less electric cardioversion and radiofrequency catheter ablation than the males. Women with CHA2DS2-VA score of 1 received far more NOAC than men. Further study is needed to find out whether these differences will bring clinically meaningful impact.