GENDER DIFFERENCE IN DEVELOPMENT OF HEART FAILURE IN NON-VALVULAR LONE ATRIAL FIBRILLATION WITH HYPERTENSION

Objective: Atrial fibrillation is frequently accompanied by hypertension. Heart failure is a critical clinical consequence of atrial fibrillation. Women with atrial fibrillation have a higher risk for embolic stroke than men. We aimed to find out whether the risk of developing heart failure was also higher in women in the patient with non-valvular atrial fibrillation (NVAF) with hypertension. Design and method: We analyzed 318 consecutive adult NVAF with hypertension in Inha university hospital in Incheon, Korea from September 2009 to April 2024. Patients with LV systolic dysfunction (LVEF<50%) were excluded. Mean age was 70.1 ± 10.8 years and 39.3% (n=125) was female. Mean LV ejection fraction and E/e’ were 60.2 ± 5.2% and 12.6 ± 4.4. Results: For the median follow-up period of 60.3 months, a total of 61 (19.2%) patients were diagnosed with heart failure. Heart failure occurrence rate was significantly higher in women (29.6% vs. 12.4%, p<0.01) than men. There were no significant differences in baseline age (72.1 ± 11.0 vs. 69.6 ± 10.7 years, p=0.11), BMI (25.8 ± 4.5 vs. 25.7 ± 3.6 kg/m2, p=0.85), E/e’ (13.5 ± 4.3 vs. 12.4 ± 4.4 p=0.09), and LVEF (59.3 ± 5.0 vs. 60.4 ± 5.2%, p=0.132). Prevalence of diabetes, CAD, and CKD were not significantly different in heart failure group. We analyzed cumulative hazard ratio of women comparing to men for the risk of heart failure adjusting other factors such as age, BMI, presence of diabetes, CKD, CAD, and echocardiographic parameters including LVEF and E/e’. Multivariate Cox regression analysis showed that the incidence of heart failure was 2.1 times as high in women after adjusting other factors. (HR 2.12 95% CI 1.22-3.70 p<0.01)Conclusions: Heart failure occurred more than twice as often after NVAF in women than men. More strict heart failure risk management including blood pressure control is needed in women with atrial fibrillation and hypertension.