Incident atrial fibrillation according to gender in patients with ischemic stroke: A nationwide cohort study

Abstract

CHA 2 DS 2 -VASc score is a tool estimating the risk of stroke in patients with atrial fibrillation (AF). This score is also able to identify patients at higher risk of AF following ischemic strokes (IS) among patients without known AF. We compared gender-related differences in items from CHA 2 DS 2 -VASc score and their relationship with possible AF occurrence dissimilarities in men and women after IS. This French longitudinal cohort study was based on the national database covering hospital care from 2009 to 2012 for the entire population. Of 336,291 patients with IS from 2009 to 2012, 240,459 (71.5%) did not have AF at baseline. A total of 14,095 (5.9%) of these patients were diagnosed as having AF during a follow-up of 7.9 ± 11.5 months (incidence rate 8.9 per 100 person-years, 50.3% female, 49.7% male). The total incidence of AF was superior in women (9.8%) than in men (8.2%). In patients with IS without pre-existing AF at baseline, increasing CHA 2 DS 2 -VASc score was associated with a risk of new onset (or previously undiagnosed) AF during follow-up (overall HR 1.43 CI 1.41–1.45, HR 1.48 CI 1.45–1.50 in men and HR 1.46 CI 1.44–1.49 in women). In the total population, predictors of incident AF were older age, hypertension, heart failure, non-cerebral systemic embolism and vascular/coronary artery disease with similar results in men and women except for peripheral/vascular disease (NS) and non-cerebral systemic embolism (NS) in men. Diagnostic values of the CHA 2 DS 2 -VASc score for identifying patients at higher risk of incident AF were similar between men (C statistics 0.720, 95% CI 0.717–0.722) and women (C statistics 0.702, 95% CI 0.699–0.704). A strategy using CHA 2 DS 2 -VASc score for identifying a higher risk of incident (or previously unknown) AF after IS might be similarly proposed in both genders because most results were similar in both groups and because sex-ratio of new AF after stroke was close to 1.