Gender differences in outcomes after surgical ablation of atrial fibrillation

Sonia V. Shah*, Jane Kruse, Adin Cristian Andrei, Zhi Li, S. Chris Malaisrie, Bradley P. Knight, Rod S. Passman, Patrick M. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Gender disparities have been established in patients who have atrial fibrillation (AF), and in their outcomes after medical treatment for AF. This study evaluated differences in outcome by gender in patients who underwent surgical treatment for AF. Methods From April 2004 to December 2012, a total of 936 patients had surgical treatment for AF. Outcomes were analyzed by gender using propensity score-matching methods. Results Of the 936 subjects, 571 (61%) were men; women were older (aged 68.6 ± 11.3 vs 66.9 ± 11.9 years; P =.033), had more heart failure (44% vs 37%; P =.024), more mitral valve surgery (72% vs 50%; P <.001) and more tricuspid valve surgery (41% vs 18%; P <.001). Men underwent more coronary artery bypass surgery (37% vs 19%; P <.001) and aortic valve surgery (38% vs 31%; P =.029). Women had higher late stroke rate per 10 person-years (0.15 vs 0.07; P =.035), fewer catheter ablations (6.0% vs 9.8%; P =.017), and a trend toward fewer cardioversions for recurrent AF (15.7% vs 19.2%; P =.20). After propensity-score matching, late stroke rates per 10 person-years trended higher in women (0.12 vs 0.04; P =.13). No significant gender differences were found in overall survival (5-year survival: 78.8% in men, and 81.0% in women; P =.40) or freedom from AF without antiarrhythmic drugs at last follow-up (71.8% in men vs 73.6% in women, P =.59). Conclusions Women sought surgery treatment at older ages and with more heart failure. No gender-based differences were found in stroke, overall survival, or procedure success, after propensity-score matching.

Original languageEnglish (US)
Pages (from-to)391-398.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Atrial Fibrillation
Propensity Score
Stroke
Survival
Heart Failure
Electric Countershock
Tricuspid Valve
Catheter Ablation
Anti-Arrhythmia Agents
Therapeutics
Aortic Valve
Mitral Valve
Coronary Artery Bypass

Keywords

  • atrial fibrillation
  • outcomes
  • quality care management

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{c1f302d9f0d7454c99b945e78ec10eed,
title = "Gender differences in outcomes after surgical ablation of atrial fibrillation",
abstract = "Background Gender disparities have been established in patients who have atrial fibrillation (AF), and in their outcomes after medical treatment for AF. This study evaluated differences in outcome by gender in patients who underwent surgical treatment for AF. Methods From April 2004 to December 2012, a total of 936 patients had surgical treatment for AF. Outcomes were analyzed by gender using propensity score-matching methods. Results Of the 936 subjects, 571 (61{\%}) were men; women were older (aged 68.6 ± 11.3 vs 66.9 ± 11.9 years; P =.033), had more heart failure (44{\%} vs 37{\%}; P =.024), more mitral valve surgery (72{\%} vs 50{\%}; P <.001) and more tricuspid valve surgery (41{\%} vs 18{\%}; P <.001). Men underwent more coronary artery bypass surgery (37{\%} vs 19{\%}; P <.001) and aortic valve surgery (38{\%} vs 31{\%}; P =.029). Women had higher late stroke rate per 10 person-years (0.15 vs 0.07; P =.035), fewer catheter ablations (6.0{\%} vs 9.8{\%}; P =.017), and a trend toward fewer cardioversions for recurrent AF (15.7{\%} vs 19.2{\%}; P =.20). After propensity-score matching, late stroke rates per 10 person-years trended higher in women (0.12 vs 0.04; P =.13). No significant gender differences were found in overall survival (5-year survival: 78.8{\%} in men, and 81.0{\%} in women; P =.40) or freedom from AF without antiarrhythmic drugs at last follow-up (71.8{\%} in men vs 73.6{\%} in women, P =.59). Conclusions Women sought surgery treatment at older ages and with more heart failure. No gender-based differences were found in stroke, overall survival, or procedure success, after propensity-score matching.",
keywords = "atrial fibrillation, outcomes, quality care management",
author = "Shah, {Sonia V.} and Jane Kruse and Andrei, {Adin Cristian} and Zhi Li and Malaisrie, {S. Chris} and Knight, {Bradley P.} and Passman, {Rod S.} and McCarthy, {Patrick M.}",
year = "2016",
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doi = "10.1016/j.jtcvs.2015.09.062",
language = "English (US)",
volume = "151",
pages = "391--398.e2",
journal = "Journal of Thoracic and Cardiovascular Surgery",
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TY - JOUR

T1 - Gender differences in outcomes after surgical ablation of atrial fibrillation

AU - Shah, Sonia V.

AU - Kruse, Jane

AU - Andrei, Adin Cristian

AU - Li, Zhi

AU - Malaisrie, S. Chris

AU - Knight, Bradley P.

AU - Passman, Rod S.

AU - McCarthy, Patrick M.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background Gender disparities have been established in patients who have atrial fibrillation (AF), and in their outcomes after medical treatment for AF. This study evaluated differences in outcome by gender in patients who underwent surgical treatment for AF. Methods From April 2004 to December 2012, a total of 936 patients had surgical treatment for AF. Outcomes were analyzed by gender using propensity score-matching methods. Results Of the 936 subjects, 571 (61%) were men; women were older (aged 68.6 ± 11.3 vs 66.9 ± 11.9 years; P =.033), had more heart failure (44% vs 37%; P =.024), more mitral valve surgery (72% vs 50%; P <.001) and more tricuspid valve surgery (41% vs 18%; P <.001). Men underwent more coronary artery bypass surgery (37% vs 19%; P <.001) and aortic valve surgery (38% vs 31%; P =.029). Women had higher late stroke rate per 10 person-years (0.15 vs 0.07; P =.035), fewer catheter ablations (6.0% vs 9.8%; P =.017), and a trend toward fewer cardioversions for recurrent AF (15.7% vs 19.2%; P =.20). After propensity-score matching, late stroke rates per 10 person-years trended higher in women (0.12 vs 0.04; P =.13). No significant gender differences were found in overall survival (5-year survival: 78.8% in men, and 81.0% in women; P =.40) or freedom from AF without antiarrhythmic drugs at last follow-up (71.8% in men vs 73.6% in women, P =.59). Conclusions Women sought surgery treatment at older ages and with more heart failure. No gender-based differences were found in stroke, overall survival, or procedure success, after propensity-score matching.

AB - Background Gender disparities have been established in patients who have atrial fibrillation (AF), and in their outcomes after medical treatment for AF. This study evaluated differences in outcome by gender in patients who underwent surgical treatment for AF. Methods From April 2004 to December 2012, a total of 936 patients had surgical treatment for AF. Outcomes were analyzed by gender using propensity score-matching methods. Results Of the 936 subjects, 571 (61%) were men; women were older (aged 68.6 ± 11.3 vs 66.9 ± 11.9 years; P =.033), had more heart failure (44% vs 37%; P =.024), more mitral valve surgery (72% vs 50%; P <.001) and more tricuspid valve surgery (41% vs 18%; P <.001). Men underwent more coronary artery bypass surgery (37% vs 19%; P <.001) and aortic valve surgery (38% vs 31%; P =.029). Women had higher late stroke rate per 10 person-years (0.15 vs 0.07; P =.035), fewer catheter ablations (6.0% vs 9.8%; P =.017), and a trend toward fewer cardioversions for recurrent AF (15.7% vs 19.2%; P =.20). After propensity-score matching, late stroke rates per 10 person-years trended higher in women (0.12 vs 0.04; P =.13). No significant gender differences were found in overall survival (5-year survival: 78.8% in men, and 81.0% in women; P =.40) or freedom from AF without antiarrhythmic drugs at last follow-up (71.8% in men vs 73.6% in women, P =.59). Conclusions Women sought surgery treatment at older ages and with more heart failure. No gender-based differences were found in stroke, overall survival, or procedure success, after propensity-score matching.

KW - atrial fibrillation

KW - outcomes

KW - quality care management

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U2 - 10.1016/j.jtcvs.2015.09.062

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