Postoperative AF: More Deaths in Women Than Men

Women are less likely to develop atrial fibrillation (AF) after open heart surgery than men. But if they do experience postoperative AF, they have a higher long-term risk for mortality. These are the results of a US study published in JAMA Network Open.
“Postoperative atrial fibrillation remains a common and clinically significant complication following cardiac surgery, posing challenges to both patients and health care professionals,” wrote Mariana Fragão-Marques, MD, PhD, MBA, from the Faculty of Medicine, University of Porto, Porto, Portugal, in an accompanying editorial. “The authors shed light on the intricate interplay between sex, postoperative atrial fibrillation, and long-term mortality after open heart surgery.”
Sex-Based Differences
Sergey Karamnov, MD, from the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital, Boston, and his colleagues analyzed the medical records of 21,568 patients, including 6601 women and 14,967 men. They underwent heart surgery at Brigham and Women’s Hospital or Massachusetts General Hospital in Boston between January 2002 and October 2016. The procedures included bypass surgery, aortic or mitral valve surgeries, or a combination of bypass and valve surgery.
After the surgeries, 40.8% of women and 38.8% of men developed postoperative AF, which was defined as AF that became visible on the ECG during the primary hospital stay in patients who had had normal sinus rhythm before the operation.
The findings changed, however, when the results were adjusted for potential confounding factors such as age, pre-existing conditions, body mass index, surgical procedures, laboratory values, and medications taken. After adjustment, the risk for postoperative AF in women was significantly lower than in men (odds ratio, 0.85).
During the follow-up period (which lasted until December 2022), 50.4% of women and 48.9% of men who developed AF after the procedure died. In the group of patients without postoperative AF, 49.6% of women and 51.1% of men died.
The investigators reported that biological sex significantly affected the association between postoperative AF and mortality. Men with postoperative AF had a 17% higher risk for mortality than men without AF.
For women with postoperative AF, the association was much clearer. They had a 31% higher risk for mortality than female patients without postoperative AF.
In the group of patients without AF, the risk for mortality did not differ between men and women.
Tailored Postoperative Care
“Our findings suggest that women may have protective factors against the development of postoperative atrial fibrillation. However, once postoperative atrial fibrillation takes place, women may be more vulnerable to the associated long-term morbidities,” the authors concluded. They add that the observed increase in risk supports offering women tailored perioperative care after heart surgery.
In her editorial, Fragão-Marques agreed that the study’s results have significant implications for clinical practice, research, and guidelines for postoperative management. “Moving forward, efforts to optimize postoperative care should prioritize a personalized, sex-specific approach that accounts for the unique biological and psychosocial factors influencing outcomes in women.”
This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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