At a recent European cardiology meeting, a retrospective cohort study1 was presented which looked at differences in hospitalization rates for acute ischemic stroke among male and female patients with atrial fibrillation over a 15 year period (1998 – 2012). The study, which included 1.1 million patients admitted to 1000 hospitals in 46 states, revealed that women had a 23% higher risk of being hospitalized for stroke than men after adjusting for such risk factors as age, diabetes, hypertension, previous stroke and heart failure. In addition, women had a higher risk of stroke compared to men regardless of race, socioeconomic status, or geographic location. According to the study authors, “women have second-rate outcomes across the board due to inadequate stroke prevention care rather than biological differences”. Why should this be so?
A previously published, related study2 that evaluated over 500,000 Medicare patients (87% white, 41% male) after newly diagnosed atrial fibrillation found statistically significant differences in the receipt of appropriate medical services (e.g. evaluation by a cardiologist, catheter ablation, anticoagulation, use of beta blockers and antiarrhythmic drugs) - especially catheter ablation (female vs male: AHR 0.65; 95% CI 0.63-0.68; P < .001) and receipt of oral anticoagulants (female vs male: AHR 0.93; 95% CI 0.93-0.94; P < .001).
Judith Wolf, MD Associate Director, WHEP
- Ghanshyam Palamaner Subash Shantha; Hardik Doshi; Anita Kumar; Gopi Dandamudi; Prashant Bhave; Alexander Mazur; Denice Hodgson-Zingman; Michael Giudici ‘Gender differences in the rates of hospitalizations for acute ischemic stroke among patients with atrial fibrillation in the United States: A 15 year experience involving 1.1 million patients’ CARDIOSTIM – EHRA EUROPACE 2016. June 8-11. Nice, France http://www.cardiostim.com/
- Bhave PD, Lu X, Girotra S, Kamel H, Vaughan Sarrazin MS. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm 2015;12(7):1406–1412.