WOMEN with permanent atrial fibrillation (AF) have a higher relative risk of heart failure (HF) than men, with smoking identified as a common risk factor, while other predictors differ by sex.
AF and HF frequently coexist, contributing to significant morbidity and mortality, yet the impact of different AF subtypes on HF risk by sex remains insufficiently understood. This study analysed data from the Tromsø Study, a large Norwegian population-based cohort, to assess sex-specific associations between AF subtypes and HF incidence. Additionally, it examined HF risk factors in AF patients and the combined influence of AF and HF on mortality.
A total of 14,790 women and 13,181 men were followed for incident AF and HF from enrolment (1994-2008) through 2016. Cox regression analyses were conducted to determine hazard ratios (HRs) and 95% confidence intervals (CIs). The findings showed that individuals with AF had a higher risk of HF compared to those without AF. Women with permanent AF exhibited a greater relative risk of HF (HR: 10.52; 95% CI: 8.72-12.70) than men with permanent AF (HR: 7.65; 95% CI: 6.40-9.15). Smoking was a common HF risk factor in both sexes, while sex-specific predictors included diastolic blood pressure and hypertension in women, and underweight, obesity, and low alcohol intake in men. Mortality risk was highest in women with AF, particularly those with paroxysmal or persistent AF (HR: 2.10; 95% CI: 1.78-2.48), and men with these AF subtypes also faced elevated mortality risk (HR: 1.66; 95% CI: 1.40-1.96). The development of HF further increased mortality risk in both sexes.
The findings highlight the importance of recognising sex-specific differences in HF risk among AF patients. Women with permanent AF require particularly close monitoring due to their elevated HF risk. Given the impact of smoking, hypertension, and body weight on HF development, targeted interventions should be integrated into clinical practice. The results suggest that personalised management strategies could improve outcomes, reducing HF incidence and subsequent mortality. Future research should explore the mechanisms underlying these sex-specific differences and assess the effectiveness of tailored prevention and treatment approaches in AF patients.
Katrina Thornber, EMJ
Reference
Espnes H et al. Heart failure in atrial fibrillation subtypes in women and men in the tromsø study.JACC Adv. 2025;4(2)101556.
