Al Khatib Ilham, Viktorisson Adam, Abzhandadze Tamar, Sunnerhagen Katharina S
Institute of Neuroscience and Physiology, Rehabilitation Medicine University of Gothenburg Gothenburg Sweden.
Department of Rehabilitation Medicine, Neurocare Sahlgrenska University Hospital Gothenburg Sweden.
J Am Heart Assoc. 2025 Apr 15;14(8):e037608. doi: 10.1161/JAHA.124.037608. Epub 2025 Apr 7.
The objective of this study was to determine associations between atrial fibrillation diagnosed after stroke (AFDAS) and known atrial fibrillation with 2-year mortality among men and women.
This longitudinal, register-based study included patients with ischemic stroke admitted to 3 hospitals in Gothenburg, Sweden, between November 1, 2014 and June 30, 2019. The exposures were known atrial fibrillation and AFDAS detected at the stroke units. The outcome was all-cause mortality 2 years after stroke. Cox-regression analyses were conducted to assess sex differences in relation to the adjusted mortality risk. Of 5468 patients with ischemic stroke, 2583 (47%) were women, and the mean age was 74 years (SD 14). Overall, 19% had known atrial fibrillation, and 10% had AFDAS. Women were older and had more severe strokes compared with men. Within the first month, women with AFDAS did not have an increased risk of mortality compared with women with no atrial fibrillation (hazard ratio, 0.93 [95% CI, 0.46-1.88]), in contrast to men with AFDAS who had an increased risk (hazard ratio, 2.14 [95% CI, 1.07-4.26]). Men and women with AFDAS had an increased risk of long-term mortality (31 days to 2 years) compared with those with no atrial fibrillation. Known atrial fibrillation was associated with the highest poststroke mortality irrespective of sex and time interval.
Our findings suggest that underlying sex differences exist in the association between the occurrence of AFDAS and poststroke mortality. Sex differences related to the timing of atrial fibrillation diagnosis should be considered when developing preventive measures and medical care after stroke.
本研究的目的是确定卒中后诊断出的心房颤动（AFDAS）与已知心房颤动与男性和女性2年死亡率之间的关联。
这项基于登记的纵向研究纳入了2014年11月1日至2019年6月30日期间在瑞典哥德堡3家医院住院的缺血性卒中患者。暴露因素为卒中单元检测到的已知心房颤动和AFDAS。结局为卒中后2年的全因死亡率。进行Cox回归分析以评估调整后死亡风险的性别差异。在5468例缺血性卒中患者中，2583例（47%）为女性，平均年龄为74岁（标准差14）。总体而言，19%的患者有已知心房颤动，10%的患者有AFDAS。与男性相比，女性年龄更大，卒中更严重。在第一个月内，与无心房颤动的女性相比，有AFDAS的女性死亡风险没有增加（风险比，0.93[95%CI，0.46 - 1.88]），而有AFDAS的男性死亡风险增加（风险比，2.14[95%CI，1.07 - 4.26]）。与无心房颤动的患者相比，有AFDAS的男性和女性长期死亡率（31天至2年）增加。无论性别和时间间隔如何，已知心房颤动与卒中后死亡率最高相关。
我们的研究结果表明，AFDAS的发生与卒中后死亡率之间的关联存在潜在的性别差异。在制定卒中后的预防措施和医疗护理时，应考虑与心房颤动诊断时间相关的性别差异。
