Women who undergo open heart surgery are less likely to experience abnormal heart rhythm, known as atrial fibrillation, after surgery than men but those who do develop this complication are at greater risk for early death than their male counterparts.
The study, published in JAMA Network Open and led by the Brigham and Women’s Hospital, Harvard Medical School, included more than 20,000 people (41% women), aged 67 years on average, who underwent open heart surgery. The researchers looked at links between postoperative atrial fibrillation and long-term mortality in this group.
“Women are at higher risk for postoperative morbidity and increased mortality after open heart surgery. In multiple studies, women had increased risk of postoperative congestive heart failure, sternal wound infection, kidney dysfunction, stroke, need for hospital readmission, and mortality,” write lead author Sergey Karamnov, cardiothoracic anesthesiologist in the department of anesthesiology, perioperative and pain medicine at the Brigham and Women’s Hospital, and colleagues.
“However, the association of sex with postoperative atrial fibrillation, the most common complication after cardiac surgery—which is itself associated with stroke, long-term atrial fibrillation, and mortality—remains unclear.”
The retrospective cohort study included 21,568 patients who underwent coronary artery bypass graft surgery, aortic valve surgery, mitral valve surgery, or combined procedures with cardiopulmonary bypass between 2002 and 2016 in the Massachusetts area.
Overall, 2694 women and 5805 men developed atrial fibrillation after surgery. After correcting for possible confounding factors, Karamnov and team calculated that women who had open heart surgery had a 15% lower risk of developing atrial fibrillation than men who had similar surgery.
During the follow up period, 50.4% of women and 48.9% of men with postoperative atrial fibrillation died. Similarly, 49.6% of women and 51.1% of men in the group without this complication died.
Women with postoperative atrial fibrillation seemed to be at higher risk of dying than men with the condition. Compared with same sex members of the overall cohort who did not develop this complication, men were at 17% higher and women 31% higher risk of dying than their peers.
“Our goal is to understand the protective factors that may reduce the incidence of postoperative atrial fibrillation in women, as well as the reasons for their heightened vulnerability once this complication occurs, all to improve patient outcomes and tailor care strategies,” said Karamnov in a press statement.
“The sex-based disparities we uncover likely represent a larger issue that healthcare systems must work to address, and the first step in doing so is to look for these sex-based differences in outcomes.”
