Abstract
Atrial fibrillation (AF) significantly increases the risk of stroke and disease burden and is an established predictor of poor outcomes after stroke. However, data regarding sex differences in long-term outcomes following stroke in patients with AF are scarce. We thus aimed to assess these differences. We recruited 951 consecutive patients with acute ischemic stroke and non-valvular atrial fibrillation (NVAF) treated at three hospitals in Tianjin, China, from January 2006 to September 2014. Information regarding stroke subtype, severity, risk factors, and outcomes (mortality, dependency, and recurrence) at 3, 12, and 36 months after stroke was recorded. The prevalence of NVAF was 8.4% overall, with a higher frequency in women than in men (11.3 vs. 6.9%, P < 0.001). Among patients with NVAF, women were older than men. Women were more likely than men to have severe stroke (38.8 vs. 29.5%, P < 0.001), high levels of total cholesterol and high- and low-density lipoprotein cholesterol (all P < 0.001), hypertension (69.1 vs. 61.2%, P = 0.012), dyslipidemia (29.8 vs. 20.7%, P = 0.001), and obesity (18.5 vs. 11.6%, P = 0.003); they were less likely than men to be current smokers (12.2 vs. 33.6%, P < 0.001) and to consume alcohol (0.9 vs. 13.9%, P < 0.001). There were greater risks of dependency and recurrence at 36 months after stroke in women than in men [odds ratios (95% confidence intervals), 1.64 (1.02–2.64) for dependency, P = 0.043; and 2.03 (1.28–3.20) for recurrence, P = 0.002] after adjustment for stroke subtype, severity, and risk factors. These findings suggest that it is crucial to emphasize the need for individualized stroke prevention education and promotion of healthy lifestyles in order to improve NVAF-related stroke outcomes and reduce disease burden in women.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia
There were 924 cases of non-valvular atrial fibrillation (NVAF) (97.2%) included for outcome analysis within 3 months poststroke after excluding 27 patients lost to follow-up; 841 cases (93.3%) included within 12 months poststroke after excluding
The median National Institutes of Health stroke scale (NIHSS) and modified Rankin Scale (mRS) scores were higher in women, but the Barthel index (BI) was lower than that in men
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The prevalence of AF in the general population in Western countries is reported to range from 1 to 2% [1,2,3], and it increases substantially with age [4]. Patients with AF have a fivefold increased risk of stroke compared to that of the general population [5]. Almost one-third of patients with first-ever stroke have a history of AF, which is related to a greater risk of neurological impairment, disability, increased recurrence, and more frequent dementia [6, 7]. With respect to sex differences in AF, women with AF have been shown to have an increased risk of cardiovascular events, including stroke [8, 9]. Sex differences in outcomes, including mortality, dependency, and recurrence after stroke, for patients with AF are controversial. We aimed to explore the sex differences in demographic characteristics, clinical features, previous histories of disease, and long-term outcomes after stroke in patients with AF
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