Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses

Xia Wang, Hoang T. Phan, Jingwei Li, Mathew J. Reeves, Amanda Thrift, Dominique A. Cadilhac, Jonathan William Sturm, Konstantinos Vemmos, Priyakumari Ganesh Parmar, Rita Krishnamurthi, Suzanne Lyn Barker-Collo, Valery L. Feigin, Janika Kõrv, Riina Vibo, Sook Ching Yang, Cheryl Carcel, Mark Woodward, Else Charlotte Sandset, Craig Anderson, Seana Gall

Research output: Contribution to journalReview ArticleResearchpeer-review


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.
Original languageEnglish
Pages (from-to)190-202
Number of pages13
JournalWomen's Health Reports
Issue number1
Publication statusPublished - 7 Jul 2020

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