Sex Differences in Quality of Life and their Explanatory Variables in Patients with Non-Valvular Atrial Fibrillation

Background: Women with atrial fibrillation (AF) have poorer quality of life (QoL) than men; however, the factors contributing to the poorer QoL in women is unclear. Methods: We analyzed data for 3562 patients with non-valvular AF enrolled in the China Registry of Atrial Fibrillation. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was used to evaluate QoL, which was compared between women and men. A multivariate logistic regression analysis model was used to explore factors potentially explaining the sex difference in QoL. Results: Overall, 43.3% of the cohort comprised women (n=1541) who were older than their male counterparts (72 ± 9.8 vs. 68 ± 11.9 years, P<0.001). Compared with men, women were more likely to have more symptoms, hypertension, diabetes mellitus, and heart failure. Women were less likely than men to receive catheter ablation (4.5% vs. 6.1%, P=0.044). Women also had lower physical component summary (PCS) scores (48 ± 9 vs. 51 ± 9, P<0.001) and mental component summary (MCS) scores (49 ± 10 vs. 51 ± 10, P<0.001) than men. In the multivariable analysis of the poorer PCS scores in women, patient age explained 32.9%, low socioeconomic status explained 20.0%, lifestyle explained 14.3%, cardiovascular comorbidities explained 15.7%, the presence of more symptoms explained 5.7%, and less catheter ablation explained 1.4%. These factors also explained similar proportions of the sex difference in MCS scores. Together, these factors explained 54.3% of the poorer physical function status and 46.8% of the poorer mental function status in women than men. Conclusions: Women with AF had poorer QoL than men. The following factors partly explained the poorer QoL in women: older age, low level of socioeconomic status, more cardiovascular comorbidities, less smoking and drinking, more symptoms, and less catheter ablation.