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

Wang, X; Phan, HT; Li, J; Reeves, MJ; Thrift, AG; Cadilhac, DA; Sturm, J; Konstantinos, V; Parmar, P; Krishnamurthi, R; Barker-Collo, S; Feigin, V; Cabral, NL; Carolei, A; Marini, C; Sacco, S; Correia, M; Appelros, P; Kõrv, J; Vibo, R; Yang, SC; Carcel, C; Woodward, M; Sandset, EC

Women's Health Collection

Journal article : Review

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

Abstract:: 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.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Wang, X., Phan, H. T., Li, J., Reeves, M. J., Thrift, A. G., Cadilhac, D. A., Sturm, J., Konstantinos, V., Parmar, P., Krishnamurthi, R., Barker-Collo, S., Feigin, V., Cabral, N. L., Carolei, A., Marini, C., Sacco, S., Correia, M., Appelros, P., Kõrv, J., … Sandset, E. C. (2020). Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses. Women's Health Reports, 1(1), 190–202.

MLA Style

Wang, X, et al. “Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses.” Women's Health Reports, vol. 1, no. 1, 2020, pp. 190–202.

Chicago Style

Wang, X, HT Phan, J Li, et al. 2020. “Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses.” Women's Health Reports 1 (1): 190–202.
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