Evidence mapPaperPMID 39217497Full record

ArticleEuropean heart journal2024

Gender and contemporary risk of adverse events in atrial fibrillation.

Asgher Champsi, Alastair R Mobley, Anuradhaa Subramanian, Krishnarajah Nirantharakumar, Xiaoxia Wang, David Shukla, Karina V Bunting, Inge Molgaard, Jeremy Dwight, Ruben Casado Arroyo and 12 more

Registry-linked trialAbstract read
In one paragraph

Article in European heart journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04700826 (Preventing Stroke, Premature Death and Cognitive Decline in a Broader Community of Patients With Atrial Fibrillation Using Healthcare Data for Pragmatic Research), which is not on this map. Cited by 33 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 4 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04700826 phase4recruitingnot on this map

Preventing Stroke, Premature Death and Cognitive Decline in a Broader Community of Patients With Atrial Fibrillation Using Healthcare Data for Pragmatic Research: A Randomised Controlled Trial

TypeinterventionalSponsorUniversity of BirminghamRan2021 to 2031Enrolled3,000ConditionsAtrial FibrillationArmsDirect Oral Anticoagulants
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. Guideline
  4. Guideline
  5. Trial
  6. Female sex-related stroke risk in patients with atrial flutter-comparison between CHA2DS2-VA and CHA2DS2-VASc scores.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Article
  7. Development and validation of a prediction model for ischemic stroke recurrence risk in patients with ischemic stroke and atrial fibrillation.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Article
  8. Review
  9. Article
  10. Type 1 and type 2 NSTEMI in atrial fibrillation: insights from the HERA-FIB registry.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
    Article
  11. Review
  12. Article
  13. Review
  14. Article
  15. Article
  16. Review
  17. Integrating gender medicine into modern healthcare: Progress and barriers.European journal of clinical investigation · 2025
    Review
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Asgher ChampsiInstitute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.ORCID 0000-0002-5510-1306
Alastair R MobleyInstitute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.ORCID 0000-0003-0957-4185
Anuradhaa SubramanianInstitute of Applied Health Research, University of Birmingham, University Road West, Birmingham B15 2TT, UK.ORCID 0000-0001-8875-7363
Krishnarajah NirantharakumarWest Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.ORCID 0000-0002-6816-1279
Xiaoxia WangInstitute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.ORCID 0000-0002-9703-8659
David ShuklaWest Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.ORCID 0000-0001-6229-7477
Karina V BuntingInstitute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.ORCID 0000-0003-4602-4377
Inge MolgaardPatient & Public Representatives, European Society of Cardiology, Sophia Antipolis, France.
Jeremy DwightPatient & Public Representatives, European Society of Cardiology, Sophia Antipolis, France.
Ruben Casado ArroyoDepartment of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium.ORCID 0000-0002-3876-6074
Harry J G M CrijnsDepartment of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.ORCID 0000-0003-1073-5337
Luigina GuastiDepartment of Medicine and Surgery, University of Insubria, Varese, Italy.ORCID 0000-0002-4524-4864
Maddalena LettinoCardiothoracic and Vascular Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.ORCID 0000-0003-0146-9196
R Thomas LumbersInstitute of Health Informatics, University College London, London, UK.ORCID 0000-0002-9077-4741
Bart MaesenDepartment of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.ORCID 0000-0001-8622-1450
Michiel RienstraDepartment of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.ORCID 0000-0002-2581-070X
Emma SvennbergDepartment of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.ORCID 0000-0002-6413-0870
Otilia ȚicaInstitute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.ORCID 0000-0002-6019-122X
Vassil TraykovClinic of Cardiology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria.ORCID 0000-0002-9523-6416
Stylianos TzeisCardiology Department, Mitera Hospital, Athens, Greece.ORCID 0000-0002-2007-1928
Isabelle van GelderDepartment of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.ORCID 0000-0002-7579-1201
Dipak KotechaInstitute of Cardiovascular Sciences, University of Birmingham, Medical School, Vincent Drive, Birmingham B15 2TT, UK.ORCID 0000-0002-2570-9812

Funding

British Heart Foundation Accelerator Award AA/18/2/34218MRC Health Data Research UKNational Institute for Health and Care Research 130280NIHR Birmingham Biomedical Research Centre 203326
6 · The paper itself

Abstract

BACKGROUND AND

aimsThe role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial.

methodsThe population cohort study used electronic healthcare records of 16 587 749 patients from UK primary care (2005-2020). Primary (composite of all-cause mortality, ischaemic stroke, or arterial thromboembolism) and secondary outcomes were analysed using Cox hazard ratios (HR), adjusted for age, socioeconomic status, and comorbidities.

results78 852 patients were included with AF, aged 40-75 years, no prior stroke, and no prescription of oral anticoagulants. 28 590 (36.3%) were women, and 50 262 (63.7%) men. Median age was 65.7 years (interquartile range 58.5-70.9), with women being older and having other differences in comorbidities. During a total follow-up of 431 086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs. men (95% confidence interval [CI] 0.87-0.92; P < .001) and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83-0.91; P < .001). This was driven by lower mortality in women (HR 0.86, 95% CI 0.83-0.89; P < .001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 95% CI 0.94-1.07; P = .87), any stroke or any thromboembolism (adjusted HR 1.02, 95% CI 0.96-1.07; P = .58), and incident vascular dementia (adjusted HR 1.13, 95% CI 0.97-1.32; P = .11). Clinical risk scores were only modest predictors of outcomes, with CHA2DS2-VA (ignoring gender) superior to CHA2DS2-VASc for primary outcomes in this population (receiver operating characteristic curve area 0.651 vs. 0.639; P < .001) and no interaction with gender (P = .45).

conclusionsRemoval of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation.

Indexed as

AnticoagulantsAtrial FibrillationThromboembolismAdministration, OralAdultAgedFemaleHumansIschemic StrokeMaleMiddle AgedRisk AssessmentRisk FactorsSex FactorsStrokeUnited KingdomAnticoagulantsAtrial fibrillationGenderSexStrokeThromboembolismWomen

Identifiers

PMID39217497
PMCPMC11439109

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.