Sex differences in disease profiles, management, and outcomes among people with atrial fibrillation after ischemic stroke: aggregated and individual participant data meta-analyses

Objectives: To examine sex differences in disease profiles, management, and survival at 1 and 5 years after ischemicstroke (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 undertookan individual participant data meta-analysis (IPDMA) of nine population-based stroke incidence studies conductedin 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-AFcases, with women (79.2 – 9.1, years) being older than men (76.5 – 9.5, years). Crude pooled mortality rate wasgreater 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, womenwere less likely to receive anticoagulant agents at discharge; however, greater mortality rate in women wasmostly attributable to prestroke factors. Further information needs to be collected in population-based studiesto understand the reasons for lower treatment of AF in women