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Canadian Journal of Cardiology

ARE THERE GENDER DIFFERENCES IN GUIDELINE-BASED STROKE PREVENTION MANAGEMENT AND OUTCOMES IN HIGH RISK ATRIAL FIBRILLATION PATIENTS PRESENTING TO AN ACADEMIC HOSPITAL?

      Introduction

      Few studies have examined gender differences in atrial fibrillation (AF) management and outcomes. Previous studies have shown that elderly women are less likely to be anticoagulated than men and new strategies are needed to reduce the risk of stroke. We compared past medical history and anticoagulation treatment of men and women presenting to an academic hospital with AF.

      Methods

      A total of 9,673 patients with a primary diagnosis of ECG-documented AF presenting at St. Michael’s Hospital were identified from January 2009 to December 2013. ECGs were obtained from the ambulatory, emergency department and inpatient settings. From 5,123 patients that met inclusion criteria a sample population of 317 patients was abstracted in detail. Patients aged < 65 years with prosthetic valve, death during admission, cardiac procedure within 7 days, or intensive care or coronary care unit admission at the time of AF were excluded. Patient demographics, medical history, and anticoagulation status were recorded. Stroke risk was classified according to CHADS2 scoring system.

      Results

      Among the 317 randomly sampled patients, 40% were female. The mean age was 80.7±6.9 and 77.2±7.7 years for females and males, respectively (p=0.0001). Clinical characteristics are described in Table 1.
      More women with a CHADS2≥2 were inpatients at the time of their ECG recording than men (92% versus 78%, respectively) (p=0.01). Amongst hospitalized patients with a CHADS2≥2 at the time of hospital admission, 44% of females and 31% of males were on warfarin and 5% of females and 6% of males were on a novel oral anticoagulant (NOAC). At hospital discharge, 55% of females and 48% of males were on warfarin, while 5% of females and 3% of males were on a NOAC. One year after hospital discharge, 58% of females and 49% of males with a CHADS2≥2 were on warfarin and 10% of females and 13% of males were on a NOAC.

      Conclusion

      Among older patients admitted to an academic hospital, females with AF were older and a greater proportion had a CHADS2 score ≥ 2. In contrast to prior reports, women were more likely to receive guideline-appropriate anticoagulation therapy; both genders had a high rate of INRs outside the therapeutic range.
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      BMS/Pfizer