Heart Failure and Atrial Fibrillation in Women: Pathophysiological Links, Clinical Challenges and Therapeutic Perspectives

Background and Objectives: The prevalence of heart failure and atrial fibrillation is increasing because of population aging. There are important sex-related differences in epidemiology, pathophysiology, treatment, and prognosis of patients with both heart failure and atrial fibrillation. While the overall lifetime risk of both diseases is similar between women and men, women tend to be older when diagnosed and to have more comorbidities. Materials and Methods: A narrative review was conducted by analyzing studies published across databases such as PubMed, SCOPUS, Web of Science and Google Scholar. The review focused on research about sex-related differences in patients with heart failure and atrial fibrillation, emphasizing the peculiarities in women regarding drug treatment and prognosis after cardiac device implantation. Results: Current evidence highlights the sex-related differences in patients with both heart failure and atrial fibrillation, regarding pathophysiology, clinical manifestations, and echocardiographic findings. There are data regarding possible sex-related differences also in mortality and therapy, as women tend to have longer hospital stays, but fewer reevaluations after discharge. Conclusions: Women with both atrial fibrillation and heart failure are at increased risk of stroke and other adverse outcomes which negatively affect their quality of life. Females with atrial fibrillation and heart failure tend to be less treated with rhythm control strategy and ablation, which may have a great impact on symptom burden in women compared to men.