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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, Phan, HT ORCID: 0000-0003-0506-2924, 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, Korv, J, Vibo, R, Yang, SC, Carcel, C, Woodward, M, Sandset, EC, Anderson, C and Gall, S ORCID: 0000-0002-5138-2526 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, vol. 1, no. 1 , pp. 190-202 , doi: 10.1089/whr.2020.0029.

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Abstract

Objectives: To examine sex differences in disease profiles, management, and survival at 1 and 5 years after ischemicstroke (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 undertookan individual participant data meta-analysis (IPDMA) of nine population-based stroke incidence studies conductedin 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-AFcases, with women (79.2 – 9.1, years) being older than men (76.5 – 9.5, years). Crude pooled mortality rate wasgreater 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, womenwere less likely to receive anticoagulant agents at discharge; however, greater mortality rate in women wasmostly attributable to prestroke factors. Further information needs to be collected in population-based studiesto understand the reasons for lower treatment of AF in women.

Item Type: Article
Authors/Creators: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
Keywords: management, outcome, atrial fibrillation, ischemic stroke, sex differences
Journal or Publication Title: Women's Health Reports
Publisher: Mary Ann Liebert, Inc. Publishers
ISSN: 2688-4844
DOI / ID Number: 10.1089/whr.2020.0029
Copyright Information:

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/

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