Sex/gender disparities in atrial fibrillation-related stroke risk

  

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). 

It is all too obvious that women with atrial fibrillation receive less state-of-the-art therapy for atrial fibrillation and stroke prevention compared to men.  Although the reasons behind this disparity remain uncertain, they likely include differences in presenting symptoms (see illustration) including the absence of symptoms in ~30% of women, delays in seeking medical attention (women are notorious for putting everyone else’s needs above their own), and provider bias (attributing symptoms to panic attacks or stress).  As medical professionals we need to be aware of and eliminate disparities so that we deliver appropriate, personalized care to all of our patients.

                                                                                                    

             Judith Wolf, MD             Associate Director, WHEP

 

1. 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/
2. 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.
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