Patient-reported outcome measures (PROMs) now are recognised as an essential element in clinical cardiovascular research studies. In addition, we are increasing aware of significant sex differences, not only in risk factors, clinical presentation and outcomes, but in the treatments provided to patients with cardiovascular disease. In this issue of Heart, a study by Gleason and colleagues1 compared atrial fibrillation (AF) therapy and PROMs in women versus men in a cohort of 953 AF patients (mean age 72 years). Overall, women reported more severe AF symptoms, a lower AF-related quality of life, poorer functional status, higher anxiety levels and more symptoms of depression (figure 1); these sex differences persisted even when the type of AF therapy was considered. However, in both men and women, rate control alone was associated with lower functional status and AF-related quality of life compared to a rhythm control strategy.