Gender-Specific Differences for Risk of Disability and Death in Atrial Fibrillation-Related Stroke - 18/04/17
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Abstract |
In the latest American Heart Association/American College of Cardiology/Heart Rhythm Society atrial fibrillation (AF) guidelines, CHA2DS2-VASc replaced the CHADS2 stroke risk assessment to determine prophylactic anticoagulation, reflecting female gender's association with stroke incidence in AF. However, little investigation has been pursued of potential risk factors associated with worsened stroke severity. In this study, we examined patients with AF with ischemic stroke patient characteristics associated with increased stroke severity. Using the Get With The Guidelines-Stroke database, we retrospectively identified 221 consecutive patients with AF diagnosed with acute ischemic stroke and performed in depth chart review, evaluating demographics, labs, and co-morbidities. We analyzed the modified Rankin Scale (mRS) at discharge as a surrogate for stroke severity, defining severe stroke as fatal (mRS of 6) or disabling (mRS 4 to 5), requiring max assistance with ambulation or activities of daily living. Female gender, advanced age, and decreased body surface area were associated with disabling or fatal stroke (68.3% of patients with mRS 4 to 6 vs 50% with mRS 0 to 3, 78.4 vs 71.1 year, and 1.83 vs 1.92, respectively). Using a backward elimination approach revealed a logistic regression model with statistically significant odds ratios (ORs) for female gender (OR 1.99) and age (OR 1.04), and borderline significant for a history of coronary artery disease (OR 1.89). In conclusion, female gender is associated in the AF population with a twofold risk of severe disabling or fatal ischemic stroke, a finding that persists after controlling for potential confounders. This finding highlights the potential benefit from appropriate anticoagulation use for stroke prophylaxis in the AF population.
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Dr. Martin and Dr. Labovitz had full access to the data and take responsibility for its integrity and the accuracy of the data analysis. Dr. Schabath conducted the formal data and statistical analysis of all data. All authors of this manuscript have directly participated in the planning, execution, or analysis of the study, and have read and assisted in the drafting of this manuscript. All authors approved the final version submitted and are accountable for aspects of the accuracy and integrity of the work. |
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Vol 119 - N° 2
P. 256-261 - janvier 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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