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GPs go forth

GPs must give ‘more aggressive’ treatment to women with AF than men

GPs have been urged to treat women with atrial fibrillation ‘more aggressively’ than men after it was found that women with the condition are more likely to have a heart attack, stroke and even die as a result.

Researchers from the University of Oxford found that women with the condition were twice as likely to have a stroke and had a higher risk of cardiovascular disease and death overall than men after they conducted a meta-analysis of 30 previous papers.

Cause was not identified in the study, but the researchers suggest that women with atrial fibrillation may be undertreated compared with men and call for clinicians ‘to consider more aggressive treatment of risk factors in women with atrial fibrillation’.

The study concluded: ‘Allocation of public health resources for prevention and treatment of atrial fibrillation should also consider the differential effects of atrial fibrillation by sex. Future resources should be encouraged to determine the underlying causes of the observed sex differences.’

But GP experts warned that this was too simplistic, and that for now GPs may simply want to focus on making sure they optimise control of all cardiovascular risk factors in women.

Professor David Fitzmaurice, clinical lead for primary care clinical sciences at the University of Birmingham, said: ‘It has been recognised for a long time that outcomes are worse for women with atrial fibrillation than with men, with mortality consistently higher at all ages in the Framingham cohort and is the reason being female is included as a risk factor within the CHADS2 risk equation.

‘It would seem sensible to optimise risk factor control in women, whether this translates to aggressive treatment is debateable. Further work is required to tease out the reasons for the worsening outcomes in women which are likely to be more complex than simple under-treatment.’

However, GP Dr Matthew Fay believes the study highlights important considerations for primary care.

He said: ‘This is an interesting piece and just highlights how much we need to see atrial fibrillation as not just an issue of thromboembolic stroke but also as risk factor for cardiovascular disease.

‘This really highlights the need to leave CHADS2 in our past, which has always underestimated the risk in women.’





Readers' comments (4)

  • Aggressive as in shout at them?......

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  • in other news yesterday, GPs were urged not to naively follow guidelines designed for single-disease patients in multimorbid patients.

    What proportion of AF patients are not multimorbid?

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  • What a sexist statement!

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  • Samuel Lewis

    Nothing actually new here, evidence-wise.

    30 studies going back 20+ years were metanalysed. Women with AF had twice the stroke risk that men had. This merely confirms the inclusion of gender in the Chads2 and cha2ds2vasc scores, which OVERestimate current stroke risk. "Aggresive" anticoagulation should be offered when benefits exceed risks, as before.

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