Sex-related differences in self-reported treatment burden in patients with atrial fibrillation

Miroslav Mihajlovic; Jelena Simic; Milan Marinkovic; Vladan Kovacevic; Aleksandar Kocijancic; Nebojsa Mujovic; Tatjana S Potpara

doi:10.3389/fcvm.2022.1029730

Sex-related differences in self-reported treatment burden in patients with atrial fibrillation

Front Cardiovasc Med. 2022 Nov 4:9:1029730. doi: 10.3389/fcvm.2022.1029730. eCollection 2022.

Authors

Miroslav Mihajlovic^{1

2}, Jelena Simic¹, Milan Marinkovic², Vladan Kovacevic², Aleksandar Kocijancic², Nebojsa Mujovic^{1

2}, Tatjana S Potpara^{1

2}

Affiliations

¹ School of Medicine, University of Belgrade, Belgrade, Serbia.
² Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia.

Abstract

Background: Treatment burden (TB) is defined as the patient's workload of healthcare and its impact on patient functioning and wellbeing. High TB can lead to non-adherence, a higher risk of adverse outcomes and lower quality of life (QoL). We have previously reported a higher TB in patients with atrial fibrillation (AF) vs. those with other chronic conditions. In this analysis, we explored sex-related differences in self-reported TB in AF patients.

Materials and methods: A single-center, prospective study included consecutive patients with AF under drug treatment for at least 6 months before enrollment from April to June 2019. Patients were asked to voluntarily and anonymously answer the Treatment Burden Questionnaire (TBQ). All patients signed the written consent for participation.

Results: Of 331 patients (mean age 65.4 ± 10.3 years, mean total AF history 6.41 ± 6.62 years), 127 (38.4%) were females. The mean TB was significantly higher in females compared to males (53.7 vs. 42.6 out of 170 points, p < 0.001), and females more frequently reported TB ≥ 59 points than males (37.8% vs. 20.6%, p = 0.001). In females, on multivariable analysis of the highest TB quartile (TB ≥ 59), non-vitamin K Antagonist Oral Anticoagulant (NOAC) use [Odds Ratio (OR) 0.319; 95% Confidence Interval (CI) 0.12-0.83, P = 0.019], while in males, catheter ablation and/or ECV of AF (OR 0.383; 95% CI 0.18-0.81, P = 0.012) were negatively associated with the highest TB quartile.

Conclusion: Our study was the first to explore the sex-specific determinants of TB in AF patients. Females had significantly higher TB compared with males. Approximately 2 in 5 females and 1 in 5 males reported TB ≥ 59 points, previously shown to be an unacceptable burden of treatment for patients. Using a NOAC rather than vitamin K antagonist (VKA) in females and a rhythm control strategy in males could decrease TB to acceptable values.

Keywords: atrial fibrillation; female sex; quality of life; sex-related differences; treatment burden.