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Published on: February 26, 2013
Sex Differences and 2-Year Mortality in Patients With Atrial Fibrillation Diagnosed After Stroke and Known Atrial
Ilham Al Khatib1, Adam Viktorisson1,2, Tamar Abzhandadze1,3
1Institute of Neuroscience and Physiology, Rehabilitation Medicine University of Gothenburg Gothenburg Sweden.
Insights
Men with atrial fibrillation diagnosed after stroke (AFDAS) face higher early mortality risk. Both sexes with AFDAS and known atrial fibrillation experience increased long-term mortality post-stroke.
Area of Science:
- Cardiology
- Neurology
- Stroke Medicine
Background:
- Atrial fibrillation diagnosed after stroke (AFDAS) and known atrial fibrillation are significant post-stroke complications.
- Understanding their impact on mortality, particularly sex differences, is crucial for patient care.
Purpose of the Study:
- To investigate the association between AFDAS and known atrial fibrillation with 2-year all-cause mortality in ischemic stroke patients.
- To determine if sex influences the relationship between AFDAS and post-stroke mortality.
Main Methods:
- Longitudinal, register-based study of ischemic stroke patients (n=5468) in Gothenburg, Sweden (2014-2019).
- Exposures: known atrial fibrillation and AFDAS. Outcome: 2-year all-cause mortality.
- Cox-regression analyses assessed sex differences in adjusted mortality risk.
Main Results:
- Women (47%) were older with more severe strokes than men.
- Early mortality: Men with AFDAS had increased risk (HR 2.14), while women did not (HR 0.93).
- Long-term mortality: Both sexes with AFDAS and known atrial fibrillation showed increased risk; known atrial fibrillation had the highest mortality.
Conclusions:
- Significant sex differences exist in AFDAS-associated post-stroke mortality.
- Timing of atrial fibrillation diagnosis and sex should inform stroke prevention and care strategies.
Background:
The objective of this study was to determine associations between atrial fibrillation diagnosed after stroke (AFDAS) and known atrial fibrillation with 2-year mortality among men and women.
Methods And Results:
This longitudinal, register-based study included patients with ischemic stroke admitted to 3 hospitals in Gothenburg, Sweden, between November 1, 2014 and June 30, 2019. The exposures were known atrial fibrillation and AFDAS detected at the stroke units. The outcome was all-cause mortality 2 years after stroke. Cox-regression analyses were conducted to assess sex differences in relation to the adjusted mortality risk. Of 5468 patients with ischemic stroke, 2583 (47%) were women, and the mean age was 74 years (SD 14). Overall, 19% had known atrial fibrillation, and 10% had AFDAS. Women were older and had more severe strokes compared with men. Within the first month, women with AFDAS did not have an increased risk of mortality compared with women with no atrial fibrillation (hazard ratio, 0.93 [95% CI, 0.46-1.88]), in contrast to men with AFDAS who had an increased risk (hazard ratio, 2.14 [95% CI, 1.07-4.26]). Men and women with AFDAS had an increased risk of long-term mortality (31 days to 2 years) compared with those with no atrial fibrillation. Known atrial fibrillation was associated with the highest poststroke mortality irrespective of sex and time interval.
Conclusions:
Our findings suggest that underlying sex differences exist in the association between the occurrence of AFDAS and poststroke mortality. Sex differences related to the timing of atrial fibrillation diagnosis should be considered when developing preventive measures and medical care after stroke.
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