Abstract 209: Sex Differences in Characteristics, Symptoms, and Management of Geriatric Patients with Atrial Fibrillation: Insights from the SAGE-AF Study

Background: Data from previous studies that examined sex differences in the characteristics, clinical presentation, and management of patients with atrial fibrillation (AF) have been inconsistent. Objective: To use data from a large contemporary cohort of older patients with AF to examine sex specific differences in baseline characteristics, symptoms, and management practices. Methods: We used data from baseline interviews and the review of medical records of participants in the Systematic Assessment of Geriatric Elements in AF (SAGE-AF) study. Participants were ≥ 65 years old with AF and a CHA2DS2-VASc≥ 2. Results: Of the 1244 participants, 49% were female. Women on average were slightly older (76.3 (7.4) vs. 74.8 (6.7) years, p<0.01), and less often had a history of coronary heart disease, diabetes, renal disease, dyslipidemia, smoking, or alcohol abuse, in comparison with men. Women reported higher rates of anxiety, depression, and frailty (27% vs. 20%, 34% vs. 23%, and 18% vs. 10%, respectively, p<0.01) when compared with men. Women had higher average CHA2DS2-VASc (4.9 (1.6) vs. 4.0 (1.5), p<0.01) but lower HAS-BLED (2.7 (1.0) vs. 3.0 (1.0), p<0.01) scores compared with men. Women more frequently reported AF-related symptoms of palpitations, irregular heartbeat, pause in heart activity, and dizziness (29% vs. 16%, 22% vs. 15%, 11% vs. 6%, and 25% vs. 19%, respectively, p<0.05) than men. Women were more likely to have paroxysmal AF (54% vs. 65%, p<0.01) than persistent AF (30% vs. 20%, p<0.01) than men. Approximately 85% of study participants received oral anticoagulants (OACs). There were no significant differences in either the rates of prescription of OACs or their classes between men and women. There were no sex differences in the choice of rate or rhythm control treatments by sex. Multivariable adjusted models showed that women were less frequently treated with cardioversion (OR=0.69, 95% CI: 0.54-0.90), pacemaker (OR= 0.73, 95% CI: 0.56-0.96), or an implanted defibrillator (OR= 0.32, 95% CI: 0.21-0.50) compared with men. Conclusion: Women with AF were older, had more psychosocial but less comorbidities, and were more symptomatic than men. While no differences in the receipt of OACs were detected, women continue to be treated more conservatively with lower rates of receipt of interventions than men.