Abstract 18038: Gender Differences in Anticoagulation and Stroke Outcomes in Atrial Fibrillation
Introduction: Women with atrial fibrillation (AF) have a higher risk of ischemic stroke than men.
Hypothesis: The primary hypothesis is that rates of anticoagulation differ between men and women with AF. The secondary hypothesis is that a difference in rate of anticoagulation results in difference in ischemic stroke-free survival in men and women with AF.
Methods: We analyzed the records of 5,976 consecutive AF patients who were prescribed at least one antiarrhythmic drug between 2006 and 2013. Time to clinical outcome events was assessed using the survival analysis method and adjusted for covariates using Cox regression.
Results: Compared to men, women (N=2,448, 41%) were older (73 vs. 67 years, p<0.001) , had higher CHADS2 scores (3.4 vs. 2.3, p<0.001), and less comorbidities including CHF, coronary artery disease, prior cardiac arrest, depression, and alcohol/tobacco use. Overall, women were less likely to be anticoagulated than men (77% vs. 83%, p<0.001). The cohort was divided into low, intermediate, or high risk of stroke by CHADS2 score, and difference in rates of anticoagulation by gender was seen in each subgroup (77% vs. 81% low, 75% vs. 83% intermediate, and 80% vs. 87% high, p<0.05). Stroke-free survival was worse in women compared to men (unadjusted p=0.05, HR 0.77), though this difference lost statistical significance when adjusted for multiple covariates (adjusted p=0.5, HR 0.93). The difference in stroke outcome between men and women was most prominent in the low risk group (Figure).
Conclusions: In our cohort, women with AF were less likely than men to be anticoagulated. In the subgroup with lowest risk of stroke, women had worse stroke-free survival.
Author Disclosures: N.A. Kassim: None. D. Qin: None. T. Richards: None. G. Leef: None. S. Saba: None.
- © 2015 by American Heart Association, Inc.