Cardiovascular Care Inequities Lead to Worse Outcomes for Women With Atrial Fibrillation

Higher rates of stroke in women with atrial fibrillation may partly be explained by inequities in cardiovascular care and older age, according to new research published in the European Heart Journal.¹

Previous studies have suggested that female sex is a risk factor for atrial fibrillation-associated stroke. There are some explanations for why this may be the case, including that women are biologically predisposed towards certain risk factors and that they tend to develop atrial fibrillation in older age when stroke rates typically rise. However, sex differences with stroke hazard in atrial fibrillation has not been completely understood.

A team of investigators from Women’s College Hospital, the Peter Munk Cardiac Centre, and the Institute for Clinical Evaluation Sciences conducted a population-based cohort study to describe sex differences in age and cardiovascular care to examine their relationship with stroke hazard in atrial fibrillation.

“Equalizing cardiovascular care for males and females is an important step towards healthier hearts and lives for everyone,” Husam Abdel-Qadir, a senior author on the study, said in a release.² “By addressing sex inequities, we can increase the likelihood that every individual receives the best chance at a heart-healthy future.”

Investigators gathered data from administrative databases in Ontario of people aged 66 years or older who were diagnosed with atrial fibrillation between 2007 and 2019. The study cohort included 354254 patients with median age of 78 years, of which 49.2% were female.

The primary study outcome was “hospitalization with a most responsible diagnosis of ischaemic stroke.” Researchers limited follow-up to 2 years and also studied cardiologist assessments, receipt of echocardiography, and dispensation of anticoagulation and statins.

Investigators found that women were more likely to be diagnosed in emergency departments, and were less likely to receive cardiologist assessments in the year before and after diagnosis with atrial fibrillation. Women were also less likely to get low-density lipoprotein-cholesterol (LDL-C) testing and be treated with statins, despite having higher levels of LDL-C and higher blood pressure than men.

Additionally, the hazard ratio for women was decreased when markers of cardiovascular health and multimorbidity were adjusted. For example, female sex was not associated with increased stroke hazard at age 80 years or older when those factors were adjusted.

“This study is another reminder that heart disease and stroke are not male diseases,” Abdel-Qadir said in a release. “Despite there being widespread appreciation that females with AF are at higher stroke risk than males, they are getting less cardiovascular care with real consequences. These data emphasize that females, particularly those at older ages, require appropriate care to reduce their risk of these serious diseases.”

References

1. Buhari H, Fang J, Han L, et al. Stroke risk in women with atrial fibrillation. Eur Heart J. Published online August 30, 2023. https://doi.org/10.1093/eurheartj/ehad508

2. Inequities in cardiovascular care are putting older female’s heart health at risk. News Release. ICES. August 30, 2023. Accessed August 31, 2023. https://www.eurekalert.org/news-releases/999758