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Stroke risk higher for older women with AF, despite anticoagulant use
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Older women with atrial fibrillation were more likely to experience stroke, as compared with men, regardless of risk profile and warfarin use.
Researchers enrolled more than 83,000 patients (52.8% women) aged at least 65 years who were admitted to the hospital with recently diagnosed AF from 1998 to 2007 in Quebec, Canada in a population-based cohort study. They evaluated patient administrative data with linkages between prescription drug claims, physician claims and hospital discharge databases. The main outcome measure was stroke risk.
Overall, women were older and had a higher CHADS2 score vs. men (1.99 vs. 1.74; P<.001). More women filled a prescription for warfarin at 30 days post-discharge (60.6% vs. 58.2%) and an adjusted analysis also revealed that women appeared to fill more warfarin prescriptions than men (OR=1.07; 95% CI, 1.04-1.11). Both men and women demonstrated good adherence to warfarin therapy.
Women had a higher crude stroke incidence compared with men (2.02 per 100 person-years; 95% CI, 1.95-2.10 vs. 1.61; 95% CI, 1.54-1.69). Differences in stroke risk between sexes were primarily driven by rates in patients aged 75 years or older. Multivariable Cox regression analysis also showed, after adjusting for baseline comorbid conditions, individual components or the CHADS2 score and warfarin treatment, women had higher risk for stroke vs. men (adjusted HR=1.14; 95% CI, 1.07-1.22).
“Our results suggest that elderly women with AF may need to be targeted for more effective stroke prevention therapy,” the researchers concluded. “Clinicians should be aware of the elevated stroke risk in older women with AF, and new strategies should be applied to effectively prevent stroke equally in men and women.”
Disclosure: The researchers report receiving support from the Canadian Institutes of Health Research and the Fonds de recherché en santé du Quebec.
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