Background and aims: Despite guidelines recommending antithrombotic therapy for atrial fibrillation (AF) patients, differences in treatment initiation between sex remain an area of ongoing research. This study assesses the association between
sex and the likelihood of receiving antithrombotic therapy following an AF diagnosis.
Methods: A retrospective multicenter cohort study was conducted using data from the IQVIA™ Disease Analyzer database,
comprising 118 cardiology practices in Germany. Patients≥18 years with a first-time AF diagnosis between 2010 and 2023
were included. The primary outcome was the prescription of vitamin K antagonists, direct thrombin inhibitors, or direct factor Xa inhibitors within 30 days post-diagnosis. Multivariable logistic regression models examined the association between
sex and therapy initiation, adjusting for age, CHA₂DS₂-VA Score, and health insurance coverage.
Results: Among 166,005 patients (74,755 female, 91,250 male), female patients were significantly older than their male counterparts, with a mean age of 76.2 years compared to 73.2 years (p<0.001). They however had a similar median CHA2DS2-VA
Score (2). Overall, the proportion of patients with antithrombotic prescriptions were lower in females (13.2%) compared to
males (15.5%, p<0.001). Multivariable regression revealed a negative association between female sex and therapy initiation
(OR: 0.89; 95% CI: 0.86–0.91, p<0.001).
Conclusion: Our findings indicate notable disparities in the initiation of antithrombotic therapy in relation to sex, thus
underscoring the necessity for additional research to comprehend the underlying factors. Consequently, efforts should be
concentrated on enhancing adherence to treatment guidelines, addressing sex-specific barriers to therapy, and ensuring
equitable access to optimized stroke prevention strategies for patients with AF.
