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Sex differences in disease profiles, management, and outcomes among people with atrial fibrillation after ischemic stroke: aggregated and individual participant data meta-analyses

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Wang, X and Phan, HT and Li, J and Reeves, MJ and Thrift, AG and Cadilhac, DA and Sturm, J and Konstantinos, V and Parmar, P and Krishnamurthi, R and Barker-Collo, S and Feigin, V and Cabral, NL and Carolei, A and Marini, C and Sacco, S and Correia, M and Appelros, P and Korv, J and Vibo, R and Yang, SC and Carcel, C and Woodward, M and Sandset, EC and Anderson, C and Gall, S, 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) pp. 190-202. ISSN 2688-4844 (2020) [Refereed Article]


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Copyright Statement

Copyright 2020 Xia Wang et al. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

DOI: doi:10.1089/whr.2020.0029

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 (19932014). 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; 1.011.51; 5-year 1.12; 1.031.22). However, the sex difference was greatly attenuated after accounting for age, prestroke function, and stroke severity (1-year 1.09; 0.971.22; 5-year 0.98; 0.841.16). Women were less likely to have anticoagulant prescription at discharge (odds ratio [OR] 0.94; 95% CI: 0.890.98) 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.

Item Details

Item Type:Refereed Article
Keywords:management, outcome, atrial fibrillation, ischemic stroke, sex differences
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Phan, HT (Dr Hoang Phan)
UTAS Author:Gall, S (Associate Professor Seana Gall)
ID Code:139848
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-07-08
Last Modified:2020-08-04
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