Arrhythmias & electrophysiology

Sex-Specific Temporal Trends in the Incidence of Heart Failure Among Patients With Atrial Fibrillation: A Population-Based Study

JACC Clin ElectrophysiolPublished territory-wide clinical registry

Authors' conclusion

Despite an overall decrease in the risk of HF among AF patients over two decades of follow-up, women retained elevated residual adjusted HF risk after full adjustment for time-varying comorbidities.

Study context

Population
Patients newly diagnosed with atrial fibrillation (AF) in Hong Kong between 1997 and 2021individuals with newly diagnosed AF (median age: 76.6 years, IQR: 60.4–92.8, 48.6% female)
Participants
130,132 patients
Exposure
Sex differences in the temporal trend of incident heart failure (HF) among patients with atrial fibrillation (AF)
Outcome
Annual IR (per 1000 person-years) of HF
Follow-up
Between 1997 and 2021
Methodological detailsPoisson regression analysis, Multivariate adjusted Fine-Gray regression models, all-cause mortality as a competing event
  • Poisson regression analysis
  • Multivariate adjusted Fine-Gray regression models
  • All-cause mortality as a competing event

Main finding

As reported in the abstract

Women

69.6 to 16.7

annual incidence rate (IR) · per 1000 person-years

Men

44.5 to 13.7

annual IR · per 1000 person-years

Observational data: associations, not effects.

Further findings

IR, per 1000 person-years

OutcomeWomenMenIncidence rate ratio (95% CI)
HF incidence, entire follow-up periodHigher risk of HF in women25.319.31.34 (1.31–1.37)

Baseline characteristics by sex

Women were older at the time of diagnosis of AF, had higher baseline CHA2DS2-VASc scores, and were more likely to be prescribed reduced doses of direct oral anticoagulants

Original publication

Sex-Specific Temporal Trends in the Incidence of Heart Failure Among Patients With Atrial Fibrillation: A Population-Based Study. JACC Clin Electrophysiol. Published 18 September 2026. doi:10.1016/j.jacep.2026.08.014

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