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Stroke risk factors and outcomes among hospitalized women with atrial fibrillation

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Abstract

Observational cohort analyses suggest that women with atrial fibrillation (AF) endure a greater burden of stroke. We conducted an analysis of an observational cohort study completed at our tertiary care medical center to assess sex-related differences in cardiovascular risk factors, prescription of antithrombotic therapy, and 90-day outcomes. We analyzed 5000 hospitalized patients with AF: 1888 women and 3112 men. Clinical characteristics of AF, risk of stroke and bleeding, prescription of antithrombotic therapy, and 90-day clinical outcomes, including stroke and all-cause mortality, were compared. We observed a 50% higher relative frequency of stroke in hospitalized women with AF compared with men. While the frequencies of prescription of antithrombotic therapy at discharge were similar, anticoagulation was omitted in 40% of women with AF. The 90-day frequencies of major adverse events and mortality were increased in hospitalized women with AF not prescribed antithrombotic therapy at discharge. Prescription of anticoagulation in women with AF at hospital discharge was associated with a 60% and 40% relative reduction in the odds of mortality and major adverse events at 90 days. In conclusion, women hospitalized with AF have a higher risk of stroke at 90 days compared with men. Anticoagulation at hospital discharge was omitted in 40% of women with AF, but when prescribed, was associated with a reduction in mortality and major adverse events at 90 days, respectively.

Graphic abstract

We analyzed 5000 hospitalized patients with atrial fibrillation (AF) (1888 women and 3112 men) in an observational cohort study completed at our tertiary care medical center to assess sex-related differences in cardiovascular risk factors, prescription of antithrombotic therapy, and 90-day outcomes. We observed a 50% higher relative frequency of stroke in hospitalized women with AF compared with men. The 90-day frequencies of major adverse events and mortality were increased in hospitalized women with AF not prescribed antithrombotic therapy at discharge. Prescription of anticoagulation in women with AF at hospital discharge was associated with a 60% and 40% relative reduction in the odds of mortality and major adverse events at 90 days.

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Data availability

The authors agree to provide the study data upon request.

Code availability

The authors agree to provide our electronic health record search strategy upon request.

Abbreviations

AF:

Atrial fibrillation

BWH:

Brigham and Women’s Hospital

DOAC:

Direct oral anticoagulant

EHR:

Electronic health record

INR:

International Normalized Ratio

ISTH:

International Society on Thrombosis and Haemostasis

LMWH:

Low-molecular weight heparin

TIA:

Transient ischemic attack

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Funding

This investigator-initiated study was funded, in part, by an unrestricted research grant from Bristol-Myers Squibb/Pfizer Alliance.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Gregory Piazza

  2. Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Shelley Hurwitz

  3. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Samuel Z. Goldhaber

Authors
  1. Gregory Piazza
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  2. Shelley Hurwitz
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  3. Samuel Z. Goldhaber
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Contributions

All authors have conceived/designed the study and/or analyzed/interpreted the data, drafted or revised the manuscript for intellectual content, and approved the final submitted manuscript.

Corresponding author

Correspondence to Gregory Piazza.

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Conflicts of interest

Dr. Piazza has received research support from Bristol-Myers Squibb/Pfizer Alliance, Bayer, Janssen, Portola, and BSC and consulting fees from Pfizer, Bayer, Janssen, Agile, and Amgen. Dr. Goldhaber has received research support from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer Alliance, BSC, Johnson & Johnson, and Janssen and consulting fees from Boehringer Ingelheim, Bayer, and Agile. Dr. Hurwitz has no conflicts of interest to disclose.

Ethical approval

The study was approved by the Institutional Review Board of Partners HealthCare System.

Consent to participate

The Institutional Review Board waived the requirement of informed consent.

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All authors have approved submission of this manuscript.

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Piazza, G., Hurwitz, S. & Goldhaber, S.Z. Stroke risk factors and outcomes among hospitalized women with atrial fibrillation. J Thromb Thrombolysis 52, 1023–1031 (2021). https://doi.org/10.1007/s11239-021-02482-8

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  • DOI: https://doi.org/10.1007/s11239-021-02482-8

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