Age- and sex-stratified risk for heart failure in patients with atrial fibrillation
Q Cheng, C Caram Deelder, L F Laurens, S C Cannegieter, H J Guchelaar, N van ReinAbstract
Background
Females with atrial fibrillation (AF) has been reported to have a higher risk of heart failure (HF) than males, although the mechanism remains unclear.
Purpose
This study aims to explore age- and sex-specific risks for HF in AF patients.
Methods
Using data from Statistics Netherlands (Centraal Bureau voor de Statistiek, CBS), we included a cohort of incident AF patients without HF from 2015 to 2023. Follow-up started from AF diagnosis until the outcome (incident HF), death or end of follow-up. Incidence rate were calculated and adjusted hazard ratios (aHRs) for HF by age were estimated by Cox regression. Factors associated with HF in AF patients by sex were further examined in an interaction analysis with females without the risk factor serving as refence.
Results
Among 229,878 included patients (43.9% females, mean age 72.0 ± 12.5 years), 26,730 (11.6%) experienced HF during follow-up (median 2.83 years). Females versus males had a higher incidence rate of HF (3.86, 95%CI 3.79-3.93 versus 3.24, 95%CI 3.19-3.30/100 person-years resp.). Female compared with male sex was associated with a relative risk of HF of 1.18 (95%CI 1.15-1.21), which decreased towards unity after adjusting for age (aHR 0.96, 95%CI 0.94-0.98). Chronic obstructive pulmonary disease, peripheral artery disease, valvular heart disease and chronic kidney disease were consistently associated with incident HF in both sexes (aHRs > 1.5). Among individuals with atherosclerosis, female versus male sex was associated with an increased risk of HF (aHR 1.54, 95%CI 1.46-1.61 versus 1.28, 95%CI 1.23-1.33 resp.). Nevertheless, female versus male sex in anaemia patients was associated with a decreased risk of HF (aHR 1.41, 95%CI 1.34-1.48 versus 1.63 95%CI 1.55-1.71).
Conclusion
Differences between sexes regarding HF risk were mainly explained by age. However, sex-specific comorbidities were associated with HF. These results support sex- and comorbidity-specific HF risk assessment in AF patients.