Discussion
SECONDARY
Four findings in the present report are particularly noteworthy. First, the mean baseline QOL scores for women in CABANA were worse than those for the men, and the women had a greater symptom burden compared with men. The mean baseline AFEQT score for women was about 10 points lower, a clinically consequential difference. Second, ablation offered significant QOL improvements over drug therapy for both women and men at 12 months, but the treatment effect sizes attenuated thereafter in both groups. Third, women and men had quantitatively comparable improvements in incremental QOL benefit from ablation, but these benefits over drug therapy were primarily accrued by those with worse baseline QOL. Finally, among ablation‐treated patients, absolute sex differences in QOL, as reflected in mean AFEQT and MAFSI scores, persisted over the CABANA follow‐up, suggesting that lower rates of use of ablation in women is not a sufficient primary explanation for previously reported worse QOL in women with AF. Furthermore, CABANA suggests that increased use of ablation alone will not provide women parity with men in AF‐related QOL.The CABANA trial, which enrolled >800 women, provides one of the largest randomized comparisons of AF management strategies in women to date and offers a unique opportunity to examine sex‐specific QOL outcomes related to AF management. Consistent with prior work, baseline QOL for women with AF in CABANA was notably worse than for the men enrolled in the trial, both in terms of symptom burden and AF‐related QOL. These findings are consistent with prior observational work.The observation that women and men with AF differ in QOL outcomes builds on >20 years of clinical investigations into AF sex‐related differences in presentation, treatment, and outcomes.In the CABANA cohort, ablation offered significant QOL improvement over drug therapy for all participants at 12 months; this assessment was a major prespecified secondary end point of the CABANA trial. In that overall intention‐to‐treat analysis, there was significant benefit of ablation over drug therapy, which did not appear to differ by sex in post hoc analysis.When we divided patients into those with better (≥70) or worse (<70) baseline AFEQT summary scores, the mean QOL difference in AFEQT summary scores between ablation and drug therapy was larger for both women and men with lower baseline scores (Figure We also examined whether the type of AF symptoms most prominently affecting QOL differed importantly between women and men. In this context, it is relevant to note that 50% of women and 39% of men in CABANA had paroxysmal AF at trial entry.