Atrial Fibrillation Update for Women

Are you one of the 2.7 million people in the U.S. with atrial fibrillation (also known as AFib)? This irregular heartbeat can lead to serious complications like stroke, heart failure, and blood clots. To treat this potentially life-threatening condition, many people take anticoagulants, or blood thinners.

Recently, the American Heart Association, American College of Cardiology, and the Heart Rhythm Society issued guidelines for treating AFib with blood thinners. Under the new guidelines, more female AFib patients would be directed to take blood thinners.

All About AFib

In patients with AFib, the upper chambers of the heart (atria) beat irregularly and are out of synch with the lower chambers (ventricles), explains Kathryn Boling, MD, of Mercy Medical Center in Baltimore. "In AFib, blood can pool in the upper chamber of the heart, which can lead to clot formation and, if the clots break off, to stroke," she says. Even AFib patients who don't have strokes may experience symptoms like

  • Palpitations.
  • Chest pain.
  • Shortness of breath.
  • Fatigue.
  • Dizziness.

AFib can come and go, in which case it's called paroxysmal. Alternatively, it can be continuous, Boling explains.

Common AFib Treatments

There are a variety of therapies for individuals with AFib, explains John Higgins, MD, an associate professor of cardiology at The University of Texas Health Science Center at Houston and chief of cardiology at the Harris Health Systemís Lyndon B. Johnson Hospital. "Weight loss [aiming] toward a healthier weight, stress reduction therapy, meditation, and yoga help. You should avoid very hot and very cold environments, as well as salty foods, caffeine, and high fat animal foods."

But the vast majority of individuals with AFib are prescribed medications, including those that control the rate at which the heart beats, and blood thinners. Blood thinners affect the process by which blood clots, making it less likely that a dangerous clot will form. Unfortunately, with blood thinners, "The side effects include the risk of serious or even life-threatening bleeding," explains Stacey E. Rosen, MD, Vice President of Women's Health at North Shore-LIJís The Katz Institute for Women's Health in New Hyde Park, NY. "But in certain patients with AFib, blood thinners have been shown to significantly reduce the risk of stroke."

New Guidelines Suggest Being a Woman Ups Risk for Stroke

The recent guidelines on blood thinners are notable in that simply being female is now a contributing factor for stroke, according to the Duke Clinical Research Institute, in Durham, NC. "The full adoption of the guidelines could reclassify nearly one million people with AF [AFib] who previously werenít recommended for treatment."

The new guidelines recommend the use of a risk assessment tool called CHADs-VASc, which stands for Cardiac Failure, Hypertension, Age, Diabetes, and Stroke (doubled); and Vascular disease, Age 65-74 years, and Sex category. The CHADs-VASc is used to calculate the risk of a stroke for an individual patient, explains Rosen, and help determine the best treatment. The CHADs-VASc assigns points to various risk factors; the points are then added up. Most importantly here, "Being female rather than male earns one point," Rosen explains. "With the prior risk calculator, men and women were treated the same, and only those over 75 years were considered at high risk."

Now, she says, based on the use of this new risk calculator, women are considered to have a greater chance of stroke than men, even if other risk factors are the same. Under the new guidelines, the number of AFib patients for whom blood thinners are recommended would increase from about 72% to 91%. Also part of the recommendations was a reduction in the age at which patients are considered to be at risk for stroke, from 75 to 65.

What the New Guidelines Mean for You

If you are a woman with AFib, have a conversation with your doctor about whether you might be an appropriate candidate for an anticoagulant, Boling says. "Women who have a high risk of bleeding, like a history of a previous GI [gastrointestinal] bleed, recent stroke, or liver or kidney disease, may not be able to take blood thinners," she says. "Thatís why a discussion with oneís doctor is imperative for anyone previously diagnosed or suffering from AFib."

Kathryn Boling, MD, reviewed this article.

Sources

Boling, Kathryn, MD. Email interview on March 23, 2015.

Higgins, John, MD. Email interview on April 6, 2015.

Rosen, Stacey, MD. Email interview on March 24, 2015.

"AFib Resources for Patients & Professionals." American Heart Association. Page accessed April 15, 2015.

"Guidelines Suggest Blood Thinners for More Women and Seniors." Medical News Today. Last updated March 4, 2015.

"Guidelines Suggest Blood Thinners for More Women, Seniors." Duke Clinical Research Institute. March 3, 2015.

OíBrien, Emily et al. "Effect of the 2014 Atrial Fibrillation Guideline Revisions on the Proportion of Patients Recommended for Oral Anticoagulation." JAMA Internal Medicine 175, 5 (2015): 848-850.