Khunte Mihir, Chen Huanwen, Colasurdo Marco, Chaturvedi Seemant, Malhotra Ajay, Gandhi Dheeraj
Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA.
Cerebrovasc Dis. 2025;54(1):53-58. doi: 10.1159/000538108. Epub 2024 Mar 2.
Atrial fibrillation or flutter (AF) is a well-known risk factor for ischemic stroke. While female sex has been associated with higher stroke risk among AF patients, overall sex-specific real-world burdens of AF-related strokes and hemorrhages are unknown.
The 2016-2020 National Inpatient Sample was queried for hospitalizations, morbidity, and mortality due to AF-related ischemic strokes and bleeds. Patient demographic information, vascular risk factors, comorbidities, and stroke characteristics were extracted using ICD-10 codes. Overall incidences were calculated using total population estimates provided by the US Census Bureau, and relative risk was calculated by comparing annual incidences between men and women.
2,420,870 ischemic stroke hospitalizations were identified; 542,635 (22.4%) were associated with AF. Overall, women had similar risk of hospitalization due to AF-related ischemic strokes compared to men; however, women had a higher risk of morbidity and mortality (RR 1.13 and 1.17, respectively; both p < 0.001). In contrast, women had lower incidences of hospitalization, morbidity, and mortality due to AF-related bleeds (RR 0.82, 0.94, and 0.74, respectively; all p < 0.001). Among patients with AF-related ischemic strokes, women had lower rates of anticoagulation use, higher rates of large vessel occlusion, and higher stroke severity (all p < 0.001). These trends persisted among patients 80 years or older (all p < 0.001).
Women in the USA have higher incidences of morbidity and mortality from AF-related ischemic strokes than men. Future studies should investigate strategies to reduce morbidity and mortality due to AF-related strokes in women.
心房颤动或心房扑动（AF）是缺血性中风的一个众所周知的危险因素。虽然女性在房颤患者中与较高的中风风险相关，但房颤相关中风和出血的总体性别特异性实际负担尚不清楚。
查询2016 - 2020年全国住院患者样本，以获取与房颤相关的缺血性中风和出血的住院情况、发病率和死亡率。使用国际疾病分类第十版（ICD - 10）编码提取患者人口统计学信息、血管危险因素、合并症和中风特征。总体发病率使用美国人口普查局提供的总人口估计数计算，相对风险通过比较男性和女性的年发病率来计算。
共确定了2,420,870例缺血性中风住院病例；其中542,635例（22.4%）与房颤相关。总体而言，与男性相比，女性因房颤相关缺血性中风住院的风险相似；然而，女性的发病和死亡风险更高（相对风险分别为1.13和1.17；均p < 0.001）。相比之下，女性因房颤相关出血的住院、发病和死亡发生率较低（相对风险分别为0.82、0.94和0.74；均p < 0.001）。在房颤相关缺血性中风患者中，女性抗凝治疗使用率较低，大血管闭塞率较高，中风严重程度较高（均p < 0.001）。这些趋势在80岁及以上患者中持续存在（均p < 0.001）。
美国女性因房颤相关缺血性中风的发病和死亡率高于男性。未来的研究应调查降低女性房颤相关中风发病率和死亡率的策略。
