Women's Health Reports (Jun 2020)

Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses

  • Xia Wang,
  • Hoang T. Phan,
  • Jingwei Li,
  • Mathew J. Reeves,
  • Amanda G. Thrift,
  • Dominique A. Cadilhac,
  • Jonathan Sturm,
  • Vemmos Konstantinos,
  • Priya Parmar,
  • Rita Krishnamurthi,
  • Suzanne Barker-Collo,
  • Valery Feigin,
  • Norberto L. Cabral,
  • Antonio Carolei,
  • Carmine Marini,
  • Simona Sacco,
  • Manuel Correia,
  • Peter Appelros,
  • Janika K?rv,
  • Riina Vibo,
  • Sook Ching Yang,
  • Cheryl Carcel,
  • Mark Woodward,
  • Else Charlotte Sandset,
  • Craig Anderson,
  • Seana Gall

DOI
https://doi.org/10.1089/WHR.2020.0029
Journal volume & issue
Vol. 1, no. 1
pp. 190 – 202

Abstract

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Objectives: To examine sex differences in disease profiles, management, and survival at 1 and 5 years after ischemic stroke (IS) among people with atrial fibrillation (AF). Methods: We performed a systematic literature search of reports of AF at IS onset according to sex. We undertook an individual participant data meta-analysis (IPDMA) of nine population-based stroke incidence studies conducted in Australasia, Europe, and South America (1993?2014). Poisson regression was used to estimate women:men mortality rate ratios (MRRs). Study-specific MRRs were combined using random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 101 studies, the pooled AF prevalence was 23% (95% confidence interval [CI]: 22%?25%) in women and 17% (15%?18%) in men. Our IPDMA is of 1,862 IS-AF cases, with women (79.2???9.1, years) being older than men (76.5???9.5, years). Crude pooled mortality rate was greater for women than for men (1-year MRR 1.24; 1.01?1.51; 5-year 1.12; 1.03?1.22). However, the sex difference was greatly attenuated after accounting for age, prestroke function, and stroke severity (1-year 1.09; 0.97?1.22; 5-year 0.98; 0.84?1.16). Women were less likely to have anticoagulant prescription at discharge (odds ratio [OR] 0.94; 95% CI: 0.89?0.98) than men when pooling IPDMA and aggregated data. Conclusions: AF was more prevalent after IS among women than among men. Among IS-AF cases, women were less likely to receive anticoagulant agents at discharge; however, greater mortality rate in women was mostly attributable to prestroke factors. Further information needs to be collected in population-based studies to understand the reasons for lower treatment of AF in women.

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