Female Fingerprint: Sex-Specific Aspects in Patients With Atrial Fibrillation and Heart Failure

Purpose of Review Atrial fibrillation (AF) and heart failure (HF) frequently coexist and represent a major source of cardiovascular morbidity and mortality. This review summarizes current evidence on sex-specific differences in epidemiology, pathophysiology, clinical presentation, prognosis, and treatment in women with AF and HF. Recent Findings Emerging evidence indicates that women with AF and HF constitute a distinct clinical and biological phenotype. Women typically develop AF at older age, more commonly present with hypertension and HF with preserved ejection fraction (HFpEF), and report greater symptom burden and impaired quality of life. Sex-specific mechanisms including hormonal influences, atrial fibrosis, endothelial dysfunction, inflammation, autonomic dysregulation, and microvascular disease contribute to these differences. Population studies further demonstrate sex-related disparities in HF development and outcomes across AF subtypes. Summary Despite increasing awareness, women remain underrepresented in clinical trials and are less likely to receive rhythm-control strategies, catheter ablation, or device therapy. Recognition of the “female fingerprint” in AF and HF is essential for individualized risk stratification and the advancement of precision cardiovascular medicine.