Abstract
Various studies on oral anticoagulants (OAC) use among atrial fibrillation (AF) patients have shown high rates of undertreatment and the presence of sex disparity. This study used the ‘Geisinger Neuroscience Ischemic Stroke’ (GNSIS) database to examine sex differences in OAC treatment among ischemic stroke patients with the pre-event diagnosis of AF in rural Pennsylvania between 2004 and 2019. We examined sex disparities in OAC undertreatment and associated risks based on age group and ischemic stroke year. A total of 1062 patients were included in the study and 1015 patients (96%) had CHA2DS2-VASc score ≥ 2, of which 549 (54.1%) were women. Undertreatment rates were not statistically significant between men and women in the overall cohort (50.0% vs. 54.5%, p = 0.18), and male sex was not found to be a significant factor in undertreatment (OR 0.82, 95% CI 0.62–1.09, p = 0.17). The result persisted even when patients were divided into four age groups and two groups based on the study time period. The undertreatment rates in both sex groups remained consistent following the introduction of novel oral anticoagulants. In conclusion, there was no evidence of sex disparity with respect to OAC treatment, even after stratifying the cohort by age and ischemic stroke year.
Highlights
Atrial fibrillation (AF) is a major risk factor for stroke incidence and the most significant cardiac arrhythmia worldwide [1,2]
A previous study using a national registry in the United States found that women had a higher risk of undertreatment across all CHA2DS2-VASc scores [9], while an investigation in Europe found that a higher proportion of female patients received oral anticoagulation (OAC) treatment in contrast to males [13]
Sex was studied as a risk factor for undertreatment in patients with CHA2DS2-VASc ≥ 2 stratified based on age group or non-vitamin K antagonist oral anticoagulants (NOACs) use
Summary
Atrial fibrillation (AF) is a major risk factor for stroke incidence and the most significant cardiac arrhythmia worldwide [1,2]. Despite the AHA/ACC/HRS guidelines for the management of patients with atrial fibrillation [3], some studies have suggested that women have a higher risk of OAC undertreatment than men [7,8,9,10], while others have reported no significant differences [11,12]. A previous study using a national registry in the United States found that women had a higher risk of undertreatment across all CHA2DS2-VASc scores [9], while an investigation in Europe found that a higher proportion of female patients received OAC treatment in contrast to males [13]. The study examined sex disparities by evaluating undertreatment rates and risk associations, stratifying patients based on age groups and index stroke dates, mainly considering the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) in 2010
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