Key result
New-onset POAF linked to ~2.3-fold higher 1-year vascular death or stroke in females, but not males.
Why the study?
New-onset post-operative atrial fibrillation (POAF) affects approximately 1 in 3 cardiac surgery patients and is associated with adverse outcomes, but whether females who develop POAF are at higher risk for adverse outcomes compared to males was unclear.
Does new-onset post-operative atrial fibrillation increase the risk of vascular death and stroke in female compared to male patients undergoing cardiac surgery?
Cohort (n=12,234)
Yes
Does new-onset post-operative atrial fibrillation increase the risk of vascular death and stroke in female compared to male patients undergoing cardiac surgery?
Females who develop new-onset post-operative atrial fibrillation after cardiac surgery experience a significantly elevated risk of stroke and the composite of vascular death and stroke in the year following surgery, an excess risk not observed in males.
POAF associated with higher stroke risk in females but not males after cardiac surgery; leaves open whether sex-specific strategies merit prospective testing.
Background New-onset post-operative atrial fibrillation (POAF) affects approximately 1 in 3 patients after cardiac surgery and is associated with adverse outcomes. Whether females who develop POAF are higher risk for adverse outcomes compared to males is unclear. Methods VISION Cardiac Surgery was an international, prospective cohort of a representative sample of patients who underwent cardiac surgery at 22 centres, in 11 countries. Participants were enrolled pre-operatively and followed for 1 year. In patients without a pre-operative history of AF, we assessed the association of new-onset POAF, as compared to no POAF, with clinical events occurring between 30 days post-operatively and 1 year of follow up, stratifying for female and male sex. For each outcome, we created a Cox proportional hazards model adjusted for CHA2DS2-VA score, smoking, hemodialysis, prior cardiac surgery, surgery type, and antithrombotic use at hospital discharge (oral anticoagulation alone, oral anticoagulation plus antiplatelet agent, antiplatelet agent alone, or none). Results Among 12,234 eligible participants, 3,887 (31.8%) had new-onset POAF; 32.2% of females (1042/3232) and 31.6% of males (2845/9002). Compared with those without POAF, females with POAF had a significantly higher risk of the primary outcome, a composite of vascular death and stroke: (3.4% vs 1.2%, adjusted hazard ratio [aHR] 2.28 (1.36-3.83), while the same was not true for males (1.9% vs 1.6%, aHR 0.99 (0.70-1.40)), p-interaction = 0.007. The excess risk in females was driven by stroke (1.2% vs 0.3%, aHR 3.76 (1.42-9.98), and no such association was observed in males (0.7% versus 0.7%, aHR 0.73 (0.41-1.31), p-interaction = 0.004. No significant sex differences were observed in adjusted hazards for vascular death, all-cause death, congestive heart failure, major bleeding, re-hospitalization for vascular cause, or AF occurring > 30 days post-operatively. Conclusions Females who experience POAF following cardiac surgery may carry an elevated risk of stroke in the year following surgery, while males do not.
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Mcintyre et al. (2026) conducted a cohort in New-onset post-operative atrial fibrillation (POAF) after cardiac surgery (n=12,234). New-onset post-operative atrial fibrillation (POAF) stratified by sex vs. No post-operative atrial fibrillation (POAF) was evaluated on Composite of vascular death and stroke occurring between 30 days post-operatively and 1 year of follow-up (aHR 2.28, 95% CI 1.36-3.83, p=0.007 for interaction). New-onset POAF increased the 1-year risk of vascular death or stroke in females (3.4% vs 1.2%, aHR 2.28; 95% CI 1.36-3.83) but not in males (aHR 0.99; p-interaction=0.007).
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