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Experts say women are less likely than men to be diagnosed with atrial fibrillation. Lucas Ottone/Stocksy
  • Researchers are reporting that women with atrial fibrillation (AFib) have a higher risk of cognitive decline than women without the condition.
  • They also report that women in general have more rapid cognitive decline than men, whether they have AFib or not.
  • Experts say AFib is becoming more common and women with the condition are often not properly diagnosed.

Women with atrial fibrillation (AFib) experience a more rapid cognitive decline than women without the condition.

That’s according to a study published today in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Researchers analyzed medical records from the National Alzheimer’s Coordinating Center cohort, which enrolled participants in 1984. Out of 43,630 participants, 4,593 had atrial fibrillation and 39,037 did not.

The average person was 78 years old and 46% were women.

Before inclusion in the study, participants needed to have at least three annual clinic visits with neuropsychological tests and were categorized as having normal cognition, mild cognitive impairment, or dementia.

The scientists looked at the following:

  • Atrial fibrillation and baseline cognitive diagnosis
  • Atrial fibrillation and the time to progression to a cognitive diagnosis

They adjusted their analysis for age, sex, race, education, body mass index, smoking, depression, hypertension, diabetes, high cholesterol, heart failure, stroke, and sleep apnea.

The researchers compared men and women with AFib to those without the condition and examined differences by gender.

The findings included:

  • Women with AFib were three times more likely to have mild cognitive impairment and dementia at baseline compared to women without AFib.
  • Comparisons for men were not considered statistically significant.

At a four-year follow-up, 30% of the participants progressed to a worse cognitive impairment stage while 21% developed dementia.

Women were more likely to continue to a worse state, transitioning from normal cognition to mild cognitive impairment and from mild cognitive impairment to vascular dementia than women without AFib or men, with or without AFib.

“Atrial fibrillation is the most common arrhythmia or abnormal heart rhythm and the prevalence of this condition is only increasing,” said Dr. Nadia Jafar, a cardiologist with Torrance Memorial Medical Center, an affiliate of Cedars Sinai in Los Angeles who was not involved in the study.

“It is important for clinicians to promptly diagnose atrial fibrillation, as it is associated with stroke and increased mortality. Prior studies have shown that men are at greater risk for developing atrial fibrillation than women,” Jafar told Medical News Today.

“The female sex may confer a higher risk for atrial fibrillation when controlling for height and/or body size. This highlights that women should not get overlooked when assessing for atrial fibrillation, offering preventive education, and considering diagnostic testing,” she added.

The study’s authors note that symptoms of atrial fibrillation in women are often ignored by healthcare providers or attributed to stress or anxiety, so it can go undiagnosed for a long time, while men are more likely to be diagnosed and treated quickly.

This means females could have a delay in treatment. Women could also have clots that go to the small blood vessels in their brains, causing cognitive impairment but going undetected.

“The findings are interesting and likely corroborate other investigative efforts documenting a gender bias in cardiovascular medicine,” said Dr, Dennis Finkielstein, the vice-chair of cardiology at Northwell Lenox Hill Hospital in New York who was not involved in the study.

“When symptomatic, the most common symptoms people experience with atrial fibrillation are palpitations and shortness of breath,” Finkielstein told Medical News Today. “Unfortunately, historically, women presenting with these symptoms were often inferred to have a psychosomatic etiology of their complaints and a proper workup was often not pursued.”

“Once atrial fibrillation is diagnosed, we often pursue thromboembolism (i.e., stroke) prophylaxis with anticoagulants,” he added. “Going back to the last point of under-diagnosis in women, it would stand to reason that this would lead to under-treatment. Ironically, when employing modern risk scoring algorithms to assist in the decision to start anticoagulation in people with atrial fibrillation, the female gender is assigned an additional risk point.”

The researchers suggest that cognitive screening, especially in women, should be included in annual cardiology visits for adults with AFib to identify those at higher risk of cognitive disease earlier in their trajectory.