Background: Atrial fibrillation (AF) is less common in women (0.04%) compared to men (0.06%) (1). Several studies have shown that women with AF are more likely to have atypical symptoms, poorer quality of life, higher risk for stroke and they more frequently have rate compared to rhythm control, and they are less represented in the studies on direct anticoagulants (DOAC). (1-3) The primary objective of this study was to show our experience in the prevention of thromboembolic incidents and follow-up of women with paroxysmal and persistent AF.

Methods: Our study included 597 patients who were hospitalized in the University Hospital Dubrava from April 2011 to October 2017. Of the total number of patients, 311 of them were men and 287 were women. There was no significant difference in the number of women and men with paroxysmal or persistent AF. Women were older than men (70.8 vs 62.9 years). A total of 217 men and 245 women had arterial hypertension, and 56 males and 54 women had type 2 diabetes. There was no difference in body mass index and in estimated glomerular filtration rate (28.18 vs 28.87 and 70 vs 60), nor in the size of the left atrium (4.29 vs 4.22). Considering the CHA₂DS₂VAsc-score, as many as 35.5% of men had no indication for anticoagulant treatment. As we expected, women had higher CHA₂DS₂VAsc-score. There was no statistically significant difference between HATCH and LADS score between the groups. The mean follow-up time was 30 months, and in that time, there was no statistically significant difference in progression to permanent AF (74 males vs 87 women). Overall mortality as well as mortality associated with AF in women was significantly higher even after age adjustment. There was no statistically significant difference in bleeding rates between women and men. Women had warfarin in therapy more often than they had DOAC.

Conclusion: Our research has shown that we are in line with negative global trends regarding the prevention of thromboembolic incidents in women with AF. Women were rarely prescribed DOAC despite their increased thromboembolic risk. Could we influence the mortality associated with AF in women if we would prescribe them DOAC more, it is to investigate.