Abstract 18079: Female Gender Associated with Increased Disability in Ischemic Strokes Secondary to Atrial Fibrillation
Background: In the latest AHA/ACC atrial fibrillation (AF) guidelines, CHA2DS2-VASc replaced the CHADS2 assessment of stroke risk to determine prophylactic anticoagulation. This change reflects studies demonstrating increased risk of stroke in women with AF compared to men. However, the literature has not examined if this relation also applies to stroke severity. In our retrospective review of 186 consecutive patients who presented with ischemic stroke due to AF, we examined the hypothesis that women are not only at higher risk for ischemic stroke, but also at higher risk of a disabling stroke.
Methods: We explored the patients’ clinical features, including demographics, admission labs, echo results, and CHA2DS2-VASc / CHADS2 risk scores. To assess stroke severity we reviewed each patient’s modified Rankin Scale (mRS) at discharge as well as NIH stroke scale at admission and discharge. We focused on those with a fatal stroke (mRS of 6) or disabling stroke (mRS 4-5), defined as need for max assistance with ambulation or activities of daily living.
Results: Females made up 60% of the patient population examined. As expected, women had a significantly higher risk of stroke than men on review of CHA2DS2-VASc scores (4.95 ± 0.5 vs 3.78 ± 0.62, p <0.001). In comparison, CHADS2 scores were similar (2.76 ± 0.31 female vs 2.66 ± 0.46 male, p=0.1), suggesting that the increased risk is secondary to the variables unique to CHA2DS2-VASc. Review of mRS revealed a similar rate of fatal stroke (24.7% female vs 24.6% male, p= 0.98). Amongst survivors, women had a significantly higher risk of a disabling stroke (63.5% vs 47.2%, p= 0.05).
Conclusion: Multiple studies of AF and stroke have previously demonstrated that women are at higher risk to suffer ischemic strokes than men. This is supported by the larger female population in our series. However, to our knowledge this is the first study of a large series of patients with ischemic stroke secondary to AF to demonstrate the increased risk of disabling strokes amongst women with AF. This data suggests the importance of early awareness and initiation of anticoagulation for AF in the female population and indicates the need for further study into the effect of anticoagulation on the prevalence of disabling stroke in the AF population.
Author Disclosures: R.C. Martin: None. A. Patel: None. A. Rafi: None. W. Michael: None. K. Fahmi: None. M.B. Schabath: None. B. Kirby: None. S.H. Chae: None. D.Z. Rose: None. M.G. Fradley: None. W.S. Burgin: None. A.J. Labovitz: None.
- © 2014 by American Heart Association, Inc.