Lack of Anticoagulant Use in Patients with Atrial Fibrillation and Increased Risk of Thromboembolic Events According to Sex: Insights from a Multicentric Brazilian Study

Medei, Emiliano; Moll-Bernardes, Renata; Pinheiro, Martha V. T.; Sousa, Andréa S.; Abufaiad, Barbara; Feldman, Andre; Arruda, Guilherme D’andrea Saba; Monteiro, Thiago Libano Csernik; Luca, Fabio Augusto De; Henz, Benhur Davi; Albuquerque, Denilson C.; Fagundes Junior, Antonio Aurelio P.; Noya-Rabelo, Marcia M.; Camiletti, Angelina Silva; Frajtag, Rose Mary; Luiz, Ronir R.; Souza, Olga F.

doi:10.36660/abc.20240310

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Original Article • Arq. Bras. Cardiol. 121 (9) • Sept 2024 • https://doi.org/10.36660/abc.20240310i linkcopy

Lack of Anticoagulant Use in Patients with Atrial Fibrillation and Increased Risk of Thromboembolic Events According to Sex: Insights from a Multicentric Brazilian Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, and its presentation differs according to age and sex. Recent studies have revealed differences in AF among various demographic groups, including the Latin American population.

Objectives To better understand potential disparities in AF prevalence and treatment strategies in the Brazilian population through data from a large multicentric prospective registry.

Methods The Rede D’Or AF registry is a multicenter prospective observational study including patients aged ≥ 18 years with AF who were seen in the emergency department of 32 tertiary hospitals in Brazil. Patients were characterized according to sex and other baseline characteristics and were classified according to previous anticoagulant use. The lack of anticoagulant use in patients with previous indications was analyzed. Statistical significance was set at 5%.

Results The study data were from a total of 1955 patients enrolled. Male sex was more prevalent, and men were younger than the women. Due to an increased prevalence of previous AF episode and a higher CHA₂DS₂-VASc score, more women had indications for anticoagulant therapy; however, a significant proportion was not receiving this treatment. From 29 in-hospital deaths, 15 patients had previous indication for anticoagulation, but only 3 were using anticoagulants.

Conclusion This study revealed sex-related differences in the Brazilian population of patients with AF that are consistent with trends in high-income countries. The promotion of better implementation of anticoagulant and antithrombotic therapies to reduce the risk of death and thromboembolic events among women with AF in Brazil is crucial.

Atrial Fibrillation; Anticoagulants; Thromboembolism

Central Illustration
: Lack of Anticoagulant Use in Patients with Atrial Fibrillation and Increased Risk of Thromboembolic Events According to Sex: Insights from a Multicentric Brazilian Study

Caracteristics	Total		Sex				χ² Test p value
	Total		Male		Female
	n	(%)	n	(%)	n	(%)
Age
< 50 years	368	(18.9)	301	(26.8)	67	(8.1)	<0.001
50 to 69 years	667	(34.2)	434	(38.6)	233	(28.1)
> 70 years	917	(47.0)	388	(34.6)	529	(63.8)
Hypertension
No	992	(55.6)	394	(51.8)	598	(58.5)	0.005
Yes	791	(44.4)	367	(48.2)	424	(41.5)	0.005
Coronary artery disease
No	1504	(84.4)	844	(82.6)	660	(87.0)	0.012
Yes	277	(15.6)	178	(17.4)	99	(13.0)	0.012
Asthma
No	1714	(96.2)	996	(97.5)	718	(94.5)	0.001
Yes	68	(3.8)	26	(2.5)	42	(5.5)	0.001
Dilated/ischemic cardiomyopathy
No	1677	(94.2)	962	(94.1)	715	(94.2)	1.000
Yes	104	(5.8)	60	(5.9)	44	(5.8)	1.000
Renal failure
No	1717	(96.3)	982	(96.1)	735	(96.6)	0.614
Yes	66	(3.7)	40	(3.9)	26	(3.4)	0.614
Hyperthyroidism
No	1751	(98.3)	1010	(98.8)	741	(97.5)	0.043
Yes	31	(1.7)	12	(1.2)	19	(2.5)	0.043

Caracteristics	Total		Death				p value*
	Total		No		Yes
	n	(%)	n	(%)	n	(%)
Age
< 50 years	321	100.0	320	(99.7)	1	(0.3)	0.002
50 to 69 years	621	100.0	616	(99.2)	5	(0.8)
> 70 years	838	100.0	815	(97.3)	23	(2.7)
Sex
Male	1032	100.0	1016	(98.4)	16	(1.6)	0.850
Female	748	100.0	735	(98.3)	13	(1.7)	0.850
Hypertension
No	906	100.0	890	(98.2)	16	(1.8)	0.852
Yes	731	100.0	719	(98.4)	12	(1.6)	0.852
Coronary artery disease
No	1376	100.0	1355	(98.5)	21	(1.5)	0.191
Yes	260	100.0	253	(97.3)	7	(2.7)	0.191
Asthma
No	1573	100.0	1548	(98.4)	25	(1.6)	0.090
Yes	63	100.0	60	(95.2)	3	(4.8)	0.090
Dilated/ischemic cardiomyopathy
No	1540	100.0	1517	(98.5)	23	(1.5)	0.021
Yes	96	100.0	91	(94.8)	5	(5.2)	0.021
Renal failure
No	1576	100.0	1554	(98.6)	22	(1.4)	<0.001
Yes	61	100.0	55	(90.2)	6	(9.8)	<0.001
Hyperthyroidism
No	1609	100.0	1582	(98.3)	27	(1.7)	0.043
Yes	27	100.0	16	(59.3)	1	(3.7)	0.043

Caracteristics	Total		Previous anticoagulation						χ² Test p value
	Total		No indication		Previous use		Lacking anticoagulation
	n	(%)	n	(%)	n	(%)	n	(%)
No indication
< 50 years	368	100.0	329	(89.4)	27.0	(7.3)	12.0	(3.3)	<0.001
50 to 69 years	669	100.0	490	(73.2)	82.0	(12.3)	97.0	(14.5)
> 70 years	918	100.0	438	(47.7)	190.0	(20.7)	290.0	(31.6)
Hypertension
No	992	100.0	717	(72.3)	154	(15.5)	121	(12.2)	0.08
Yes	793	100.0	393	(49.6)	129	(16.3)	271	(34.2)	0.08
Coronary artery disease
No	1506	100.0	1000	(66.4)	220	(14.6)	286	(19.0)	<0.001
Yes	277	100.0	109	(39.4)	62	(22.4)	106	(38.3)	<0.001
Asthma
No	1716	100.0	1077	(62.8)	269	(15.7)	370	(21.6)	0.029
Yes	68	100.0	32	(47.1)	14	(20.6)	22	(32.4)	0.029
Dilated/ischemic cardiomyopathy
No	1679	100.0	1067	(63.5)	254	(15.1)	358	(21.3)	<0.001
Yes	104	100.0	42	(40.4)	28	(26.9)	34	(32.7)	<0.001
Renal failure
No	1719	100.0	1082	(62.9)	267	(15.5)	370	(21.5)	0.04
Yes	66	100.0	28	(42.4)	16	(24.2)	22	(33.3)	0.04
Hyperthyroidism
No	1753	100.0	1093	(62.4)	274	(15.6)	386	(22.0)	0.310
Yes	31	100.0	17	(54.8)	8	(25.8)	6	(19.4)	0.310

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[TFN1001] *Fisher test.