- Title
- Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses
- Creator
- Wang, Xia; Phan, Hoang T.; Barker-Collo, Suzanne; Feigin, Valery; Cabral, Norberto L.; Carolei, Antonio; Marini, Carmine; Sacco, Simona; Correia, Manuel; Appelros, Peter; Kõrv, Janika; Vibo, Rina; Li, Jingwei; Yang, Sook Ching; Carcel, C; Woodward, M; Sandset, EC; Anderson, C; Gall, S; Reeves, Mathew J.; Thrift, Amanda G.; Cadilhac, Dominique A.; Sturm, Jonathan; Konstantinos, Vemmos; Parmar, Priya; Krishnamurthi, Rita
- Relation
- Women's Health Reports Vol. 1, Issue 1, p. 190-202
- Publisher Link
- http://dx.doi.org/10.1089/whr.2020.0029
- Publisher
- Mary Ann Liebert
- Resource Type
- journal article
- Date
- 2020
- Description
- 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.
- Subject
- atrial fibrillation; ischemic stroke; sex differences; disease profiles; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1496673
- Identifier
- uon:54206
- Identifier
- ISSN:2688-4844
- Rights
- x
- Language
- eng
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