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Atrial Fibrillation in Women: from Epidemiology to Treatment. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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2
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Shimizu T, Ueno Y, Tateishi Y, Doijiri R, Kuriki A, Kikuno M, Takekawa H, Shimada Y, Kanemaru K, Kamiya Y, Yamaguchi E, Koga M, Ihara M, Tsujino A, Hirata K, Hasegawa Y, Hattori N, Urabe T. Evaluating the Potential Pathology and Short-Term Outcomes of Cryptogenic Stroke Using the Etiological Classification System. J Atheroscler Thromb 2022; 30:377-389. [PMID: 35691846 PMCID: PMC10067338 DOI: 10.5551/jat.63267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Various embolic sources and pathogenetic mechanisms underlie cryptogenic stroke (CS). We investigated the association of etiological diversity with short-term outcomes in patients with CS using a modified atherosclerosis (A), small-vessel disease (S), cardiac pathology (C), other causes (O), and dissection (D) (ASCOD) system. METHODS Patients with CS who underwent transesophageal echocardiography were registered in this multicenter, observational study. In the modified classification system, O and D were inapplicable and thus excluded. Instead, atherosclerosis, small-vessel disease, cardiac pathology-CS classification was specifically constructed for the etiological diagnosis of CS. We utilized this system to explore the mechanism of CS by grading each pathology and evaluated its association with poorer modified Rankin Scale scores of 3-6 at hospital discharge. RESULTS A total of 672 patients (68.7±12.8 years, 220 females) were analyzed. In the multiple logistic regression model, female sex (odds ratio [OR], 1.87 [1.15-3.04]; P=0.012), body mass index (OR, 0.93 [0.88-0.99]; P=0.025), National Institute of Health Stroke Scale score (OR, 1.16 [1.12-1.21]; P<0.001), CHADS2 score (OR, 1.56 [1.30-1.86]; P<0.001), D-dimer (OR, 1.04 [1.01-1.08]; P=0.015), diffusion-weighted image (DWI) lesion size (OR, 1.44 [1.10-1.89]; P=0.009), and S+C score (OR, 1.26 [1.03-1.56]; P=0.029) were associated with poor functional outcome at discharge whereas the S+C score was marginally associated with poor functional outcome after excluding 137 patients with a premorbid modified Rankin Scale score of ≥ 3. CONCLUSIONS The coexistence of small-vessel disease and cardiac pathology might be associated with poor in-hospital functional outcome in CS.
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Affiliation(s)
- Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital
| | - Muneaki Kikuno
- Department of Neurology, Tokyo Medical University.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kodai Kanemaru
- Department of Neurology, Tokyo Medical University.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital
| | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital
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Grundtvig J, Ovesen C, Steiner T, Carcel C, Gaist D, Christensen L, Marstrand J, Meden P, Rosenbaum S, Iversen HK, Kruuse C, Christensen T, Ægidius K, Havsteen I, Christensen H. Sex-Differences in Oral Anticoagulant-Related Intracerebral Hemorrhage. Front Neurol 2022; 13:832903. [PMID: 35309585 PMCID: PMC8927802 DOI: 10.3389/fneur.2022.832903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/31/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction and Aim Data remain limited on sex-differences in patients with oral anticoagulant (OAC)-related intracerebral hemorrhage (ICH). We aim to explore similarities and differences in risk factors, acute presentation, treatments, and outcome in men and women admitted with OAC-related ICH. Method This study was a retrospective observational study based on 401 consecutive patients with OAC-related ICH admitted within 24 h of symptom onset. The study was registered on osf.io. We performed logarithmic regression and cox-regression adjusting for age, hematoma volume, Charlson Comorbidity Index (CCI), and pre-stroke modified Ranking Scale (mRS). Gender and age were excluded from CHA2DS2-VASc and CCI was not adjusted for age. Results A total of 226 men and 175 women were identified. More men were pre-treated with vitamin K-antagonists (73.5% men vs. 60.6% women) and more women with non-vitamin K-antagonist oral anticoagulants (26.5% men vs. 39.4% women), p = 0.009. Women were older (mean age 81.9 vs. 76.9 years, p < 0.001). CHA2DS2-VASc and CCI were similar in men and women. Hematoma volumes (22.1 ml in men and 19.1 ml in women) and National Institute of Health Stroke Scale (NIHSS) scores (13 vs. 13) were not statistically different, while median Glasgow Coma Scale (GCS) was lower in women, (14 [8;15] vs. 14 [10;15] p = 0.003). Women's probability of receiving reversal agents was significantly lower (adjusted odds ratio [aOR] = 0.52, p = 0.007) but not for surgical clot removal (aOR = 0.56, p = 0.25). Women had higher odds of receiving do-not-resuscitate (DNR) orders within a week (aOR = 1.67, p = 0.04). There were no sex-differences in neurological deterioration (aOR = 1.48, p = 0.10), ability to walk at 3 months (aOR = 0.69, p = 0.21) or 1-year mortality (adjusted hazard ratio = 1.18, p = 0.27). Conclusion Significant sex-differences were observed in age, risk factors, access to treatment, and DNRs while no significant differences were observed in comorbidity burden, stroke severity, or hematoma volume. Outcomes, such as adjusted mortality, ability to walk, and neurological deterioration, were comparable. This study supports the presence of sex-differences in risk factors and care but not in presentation and outcomes.
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Affiliation(s)
- Josefine Grundtvig
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Josefine Grundtvig
| | - Christian Ovesen
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Thorsten Steiner
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - David Gaist
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Louisa Christensen
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Marstrand
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Helle K. Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Herlev Hospital, Copenhagen, Denmark
| | | | - Karen Ægidius
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Inger Havsteen
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Hanne Christensen
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Rathfoot C, Edrissi C, Sanders CB, Knisely K, Poupore N, Nathaniel T. Gender differences in comorbidities and risk factors in ischemic stroke patients with a history of atrial fibrillation. BMC Neurol 2021; 21:209. [PMID: 34034655 PMCID: PMC8146651 DOI: 10.1186/s12883-021-02214-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/19/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Atrial Fibrillation (AF) is a common cardiac arrhythmia and has been identified as a major risk factor for acute ischemic stroke (AIS). Gender differences in the disease process, causative mechanisms and outcomes of AF have been investigated. In the current study, we determined whether there is a gender-based disparity in AIS patients with baseline AF, and whether such a discrepancy is associated with specific risk factors and comorbidities. METHODS Baseline factors including comorbidities, risk and demographic factors associated with a gender difference were examined using retrospective data collected from a registry from January 2010 to June 2016 in a regional stroke center. Univariate analysis was used to differentiate between genders in terms of clinical risk factors and demographics. Variables in the univariate analysis were further analyzed using logistic regression. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each factor were used to predict the increasing odds of an association of a specific comorbidity and risk factor with the male or female AIS with AF. RESULTS In the population of AIS patients with AF, a history of drug and alcohol use (OR = 0.250, 95% CI, 0.497-1.006, P = 0.016), sleep apnea (OR = 0.321, 95% CI, 0.133-0.777, P = 0.012), and higher serum creatinine (OR = 0.693, 95% CI, 0.542-0.886 P = 0.003) levels were found to be significantly associated with the male gender. Higher levels of HDL-cholesterol (OR = 1.035, 95% CI, 1.020-1.050, P < 0.001), LDL-cholesterol (OR = 1.006, 95% CI, 1.001-1.011, P = 0.012), and the inability to ambulate on admission to hospital (OR = 2.258, 95% CI, 1.368-3.727, P = 0.001) were associated with females. CONCLUSION Our findings reveal that in the AIS patients with atrial fibrillation, migraines, HDL, LDL and poor ambulation were associated with females, while drugs and alcohol, sleep apnea, and serum creatinine level were associated with male AIS patients with AF. Further studies are necessary to determine whether gender differences in risk factor profiles and commodities require consideration in clinical practice when it comes to AF as a risk factor management in AIS patients.
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Affiliation(s)
- Chase Rathfoot
- School of Medicine Greenville, University of South Carolina, Greenville, SC, 29605, USA
| | - Camron Edrissi
- School of Medicine Greenville, University of South Carolina, Greenville, SC, 29605, USA
| | | | - Krista Knisely
- School of Medicine Greenville, University of South Carolina, Greenville, SC, 29605, USA
| | - Nicolas Poupore
- School of Medicine Greenville, University of South Carolina, Greenville, SC, 29605, USA
| | - Thomas Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC, 29605, USA.
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5
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Kumar A, McCullough L. Cerebrovascular disease in women. Ther Adv Neurol Disord 2021; 14:1756286420985237. [PMID: 33552237 PMCID: PMC7844450 DOI: 10.1177/1756286420985237] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Cerebrovascular disease is a major cause of morbidity, mortality, and disability in women. The spectrum of disease differs between men and women, with women being particularly vulnerable to certain conditions, especially during specific periods of life such as pregnancy. There are several unique risk factors for cerebrovascular disease in women, and the influence of some traditional risk factors for stroke is stronger in women. Moreover, disparities persist in representation of women in clinical trials, acute intervention, and stroke outcomes. In this review, we aimed to explore the epidemiology, etiologies, and management of cerebrovascular disease in women, highlighting some of these differences and the growing need for sex-specific management guidelines and health policies.
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Affiliation(s)
- Aditya Kumar
- Department of Neurology, 6431 Fannin Street, Houston, TX 77030, USA
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6
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Wang X, Phan HT, Li J, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Konstantinos V, Parmar P, Krishnamurthi R, Barker-Collo S, Feigin V, Cabral NL, Carolei A, Marini C, Sacco S, Correia M, Appelros P, Kõrv J, Vibo R, Yang SC, Carcel C, Woodward M, Sandset EC, Anderson C, Gall S. Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses. WOMEN'S HEALTH REPORTS 2020; 1:190-202. [PMID: 33786481 PMCID: PMC7784810 DOI: 10.1089/whr.2020.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia.,Department of Health Management and Health Economics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Jingwei Li
- Department of Cardiology, People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Vemmos Konstantinos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery Feigin
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Norberto L Cabral
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Carmine Marini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Manuel Correia
- InstitutodeCiênciasBiomédicasdeAbelSalazar, UniversidadedoPorto, Porto, Portugal
| | - Peter Appelros
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Sook Ching Yang
- Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, the University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.,The George Institute China at Peking University Health Science Centre, Beijing, PR China
| | - Seana Gall
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
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Abstract
PURPOSE OF REVIEW This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan. RECENT FINDINGS Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy complications (preeclampsia/eclampsia, preterm delivery, and stillbirth), oophorectomy, hormone replacement therapy use, and younger age at menopause all increase the risk of stroke. Although the nonreproductive risks of stroke overlap between men and women, those with greater impact on women include age, hypertension, atrial fibrillation, socioeconomic status, and depression. SUMMARY Significant sex differences are observed in risk factors of stroke and stroke outcome. Including this information in the clinical assessment of the individual patient may support development of more effective prevention plans.
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Fukuoka Y, Hosomi N, Hyakuta T, Omori T, Ito Y, Uemura J, Yagita Y, Kimura K, Matsumoto M, Moriyama M. Effects of a Disease Management Program for Preventing Recurrent Ischemic Stroke. Stroke 2019; 50:705-712. [DOI: 10.1161/strokeaha.118.020888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yasuko Fukuoka
- From the Department of Nursing Science (Y.F., M. Moriyama), Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics (N.H., M. Matsumoto), Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Takeshi Hyakuta
- Faculty of Nursing, Japanese Red Cross Hiroshima College of Nursing (T.H.)
| | - Toyonori Omori
- Nagoya City University, Graduate School of Medical Sciences, Japan (T.O.)
| | - Yasuhiro Ito
- Department of Neurology, TOYOTA Memorial Hospital, Japan (Y.I.)
| | - Jyunichi Uemura
- Department of Stroke Medicine, Kawasaki Medical School Hospital, Japan (J.U., Y.Y.)
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School Hospital, Japan (J.U., Y.Y.)
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (K.K.)
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics (N.H., M. Matsumoto), Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Michiko Moriyama
- From the Department of Nursing Science (Y.F., M. Moriyama), Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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Imam YZ, Kamran S, Akhtar N, Deleu D, Singh R, Malik RA, Abdelmoneim MS, Bermejo P, Bourke P, Morgan D, Santos M, Joseph S, Shuaib A. Incidence, clinical features and outcomes of atrial fibrillation and stroke in Qatar. Int J Stroke 2019; 15:85-89. [PMID: 30789323 DOI: 10.1177/1747493019830577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. METHODS We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. RESULTS A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P < 0.001) in atrial fibrillation patients. The modified Rankin Score (mRS) (P < 0.001) and mortality at 90-day follow-up (P = 0.002) were significantly higher in atrial fibrillation compared to non-atrial fibrillation stroke patients. CONCLUSION We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.
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Affiliation(s)
- Yahia Z Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiac Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Doha, Qatar.,Division of Cardiovascular Medicine, Central Manchester University Hospitals Foundation Trust, University of Manchester, Manchester, UK
| | - M S Abdelmoneim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Pablo Bermejo
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mark Santos
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Sex Differences in Atrial Fibrillation—Update on Risk Assessment, Treatment, and Long-Term Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:79. [DOI: 10.1007/s11936-018-0682-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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11
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Giménez-Muñoz A, Ara J, Abad Díez J, Campello Morer I, Pérez Trullén J. Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998-2010. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Giménez-Muñoz A, Ara J, Abad Díez J, Campello Morer I, Pérez Trullén J. Tendencia de las tasas de hospitalización y de letalidad hospitalaria de la enfermedad cerebrovascular aguda en Aragón en el periodo 1998-2010. Neurologia 2018; 33:224-232. [DOI: 10.1016/j.nrl.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/14/2016] [Accepted: 06/30/2016] [Indexed: 11/26/2022] Open
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Abstract
Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke - including diabetes mellitus and atrial fibrillation - are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials - despite governmental actions highlighting the need to include both men and women in clinical trials - resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.
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Ko D, Rahman F, Martins MAP, Hylek EM, Ellinor PT, Schnabel RB, Benjamin EJ, Christophersen IE. Atrial fibrillation in women: treatment. Nat Rev Cardiol 2016; 14:113-124. [PMID: 27786235 DOI: 10.1038/nrcardio.2016.171] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sex-specific differences in the epidemiology, pathophysiology, presentation, prognosis, and treatment of atrial fibrillation (AF) are increasingly recognized. Women with AF generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. Effective treatment of the arrhythmia in women is critical to reduce the rate of adverse events. We review the current evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy. In addition, we provide a critical evaluation of potential disparities and biases in health-care use that might be associated with differences in the outcomes between women and men. We underscore current knowledge gaps that need to be addressed in future studies to improve the management of AF in women. In particular, we suggest several strategies to produce high-quality evidence from randomized clinical trials for women with AF.
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Affiliation(s)
- Darae Ko
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA
| | - Faisal Rahman
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA
| | - Maria A P Martins
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia da Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte - MG, 31270-901, Brazil.,Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue, Framingham, Massachusetts 01702, USA
| | - Elaine M Hylek
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA
| | - Patrick T Ellinor
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Oudenarder Strasse 16, D/04 (1. floor), 13347 Berlin, Germany
| | - Emelia J Benjamin
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue, Framingham, Massachusetts 01702, USA.,Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118, USA
| | - Ingrid E Christophersen
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Sogneprest Munthe-Kaas vei 100, 1346 Gjettum, Norway
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15
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Affiliation(s)
- Arthur Labovitz
- From the Department of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa
| | - John Meriwether
- From the Department of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa
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16
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Nezu T, Hosomi N, Lip GY, Aoki S, Shimomura R, Maruyama H, Yagita Y, Matsumoto M, Kobayashi S. Temporal Trends in Stroke Severity and Prior Antithrombotic Use Among Acute Ischemic Stroke Patients in Japan. Circ J 2016; 80:2033-6. [PMID: 27452200 DOI: 10.1253/circj.cj-16-0374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few existing stroke registries allow for evaluation of stroke severity, stroke subtype and antithrombotic usage prior to stroke onset over a given time period. The present study aimed to elucidate temporal trends in initial presenting stroke severity, stroke subtype and prior antithrombotic use over a 12-year period in a Japanese multicenter stroke registry. METHODS AND RESULTS We included 71,017 acute ischemic stroke patients (72±12 years old; 27,445 women) from the Japan Standard Stroke Registry Study (JSSRS) who were admitted to 94 hospitals between 2001 and 2012. The mean age of stroke onset increased gradually over time (P<0.001). Cardioembolic stroke patients (n=19,247) exhibited more severe NIHSS scores when compared with those with non-cardioembolic stroke (n=50,427). The proportion of cardioembolic stroke patients tended to increase over time, rising from 25.9% in 2001-2002 to 30.2% in 2011-2012 (P<0.001). Among the cardioembolic stroke patients, the frequency of prior anticoagulant use significantly increased from 15.6% in 2001-2002 to 24.8% in 2011-2012 (P<0.001). The frequency of prior antiplatelet use increased from 2001-2002 to 2007-2008 but decreased after 2007-2008. Among both cardioembolic and non-cardioembolic stroke patients, initial stroke severity at admission decreased over time, particularly after 2008. CONCLUSIONS In this Japanese study, the mean age of ischemic stroke onset increased, while the initial neurological severity at presentation decreased, over a 12-year period. (Circ J 2016; 80: 2033-2036).
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences
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17
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Tanaka K, Yamada T, Torii T, Matsumoto S, Yoshimura T, Takase KI, Wakata Y, Nakashima N, Kira JI, Murai H. Clinical characteristics of atrial fibrillation-related cardioembolic stroke in patients aged 80 years or older. Geriatr Gerontol Int 2016; 17:708-713. [DOI: 10.1111/ggi.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/02/2016] [Accepted: 02/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takeshi Yamada
- Department of Neurology; Saiseikai Fukuoka General Hospital; Fukuoka Japan
| | - Takako Torii
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
- National Cerebral and Cardiovascular Center; Suita, Osaka Japan
| | - Shoji Matsumoto
- Department of Neurology; Kokura Memorial Hospital; Kitakyushu Japan
| | - Takeo Yoshimura
- Department of Neurology; Fukuoka City Hospital; Fukuoka Japan
| | | | - Yoshifumi Wakata
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
| | - Naoki Nakashima
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Hiroyuki Murai
- Department of Neurological Therapeutics, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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18
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Affiliation(s)
- Hayato Matsushima
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences
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19
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Hayashi T. Do the Components of CHA<sub>2</sub>DS<sub>2</sub>-VAsc Score Affect Stroke Severity and Outcome? Circ J 2016; 80:74-5. [DOI: 10.1253/circj.cj-15-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takeshi Hayashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center
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