Stroke Outcomes Worse in Women

Italian researchers report that women have a worse neurological outcome after stroke than men, and the differences cannot be attributed to age.

Marco Stramba-Badiale, MD, PhD, head of the stroke unit at the IRCCS Instituto Auxologico Italiano in Milan, and colleagues analyzed a series of 269 patients admitted for stroke and found the average National Institutes of Health Stroke Scale score at discharge was 6.6 in women and 4.2 in men. The NIH Stroke Scale is an assessment of 11 categories of neurological function, including level of consciousness and ability to respond, motor function, and language and comprehension abilities. One year later, 24% of women and 10% of men had severe neurological impairment.

The researchers presented their data at a panel discussion on women and stroke risk and stroke management during the American Stroke Association's International Stroke Conference, held February 16–18 in Kissimmee, Fla.

Stramba-Badiale says even after adjusting for the older age of women upon admission, the disparity persisted. He suggests that the reason for the worse outcomes among women was the higher prevalence of atrial fibrillation (AF) in the women in the study (41%) than in the men (22%). AF is known to be associated with severe stroke. Women also were less likely than men to receive oral anticoagulants prior to stroke, the researchers found.

This last finding is confirmed in research conducted at the University of South Florida in St. Petersburg. Vibhuti Singh, MD, MPH, and colleagues reviewed the medical records of 347 patients (131 women) with paroxysmal and persistent AF.

Warfarin was prescribed prior to stroke for 62% of the women and for 76% of the men. Among elderly stroke patients (≥70 years), oral anticoagulants were prescribed for 49% of the women and 61% of the men.

One-third of participating physicians cited advanced age as the reason for not using warfarin. Physicians said they feared that elderly women would bleed, and so they substituted aspirin, Singh reports.

“AHA guidelines call for the use of warfarin in AF,” notes panel moderator Ralph Sacco, MD, of Columbia University in New York. “These need to be better implemented.” ▪

Atrial Fibrillation and Stroke

1. An estimated 2.2 million adults in the U.S. have been diagnosed with atrial fibrillation (AF).

2. AF accounts for one fourth of all strokes in the elderly. The American Heart Association reports that AF is responsible for more than 70,000 strokes annually in the U.S.

3. Antiarrhythmia medications can help regularize the heart rhythm, and anticoagulants (aspirin and warfarin being the most common) can help reduce stroke in patients with AF.¹

4. The prevalence of AF increases with age in older adults, from <1% for people <60 years to about 10% for people ≥80 years.

5. Men have a higher prevalence of diagnosed AF than women, and whites have a higher prevalence than African Americans.²

6. Other factors associated with the development of AF include hypertension, congestive heart failure, previous myocardial infarction, and diabetes.³

7. Signs and symptoms of AF include sensation of missed or extra heart beats, an unexplained rapid heartbeat, or palpitation.

Patients can identify an irregular heartbeat by monitoring their wrist pulse for 1 minute. The irregularity of these beats is detected when the next beat cannot be predicted. If signs of cardiac arrhythmia are identified, advise patients to seek medical care to determine the presence of AF or other heart disorders.

Source: Centers for Disease Control and Prevention Atrial Fibrillation Fact Sheet, www.cdc.gov/cvh/library/fs_atrial_fibrillation.htm.