TY  - JOUR
T1  - SEx differences in stroke risk among older patients with recently diagnosed atrial fibrillation
AU  - Tsadok M, Jackevicius CA, Rahme E, Humphries KH, Behlouli H, Pilote L
Y1  - 2012/05/09
N1  - 10.1001/jama.2012.3490
JO  - JAMA
SP  - 1952
EP  - 1958
VL  - 307
IS  - 18
N2  - Context 
                  Stroke is a serious complication associated with atrial fibrillation (AF). Women with AF are at higher risk of stroke compared with men. Reasons for this higher stroke risk in women remain unclear, although some studies suggest that undertreatment with warfarin may be a cause.Objective 
                  To compare utilization patterns of warfarin and the risk of subsequent stroke between older men and women with AF at the population level.Design, Setting, and Patients 
                  Population-based cohort study of patients 65 years or older admitted to the hospital with recently diagnosed AF in the province of Quebec, Canada, 1998-2007, using administrative data with linkage between hospital discharge, physicians, and prescription drug claims databases.Main Outcome Measures 
                  Risk of stroke.Results 
                  The cohort comprised 39 398 men (47.2%) and 44 115 women (52.8%). At admission, women were older and had a higher CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack) score than men (1.99 [SD, 1.10] vs 1.74 [SD, 1.13], P < .001). At 30 days postdischarge, 58.2% of men and 60.6% of women had filled a warfarin prescription. In adjusted analysis, women appeared to fill more warfarin prescriptions compared with men (odds ratio, 1.07 [95% CI, 1.04-1.11]; P < .001). Adherence to warfarin treatment was good in both sexes. Crude stroke incidence was 2.02 per 100 person-years (95% CI, 1.95-2.10) in women vs 1.61 per 100 person-years (95% CI, 1.54-1.69) in men (P < .001). The sex difference was mainly driven by the population of patients 75 years or older. In multivariable Cox regression analysis, women had a higher risk of stroke than men (adjusted hazard ratio, 1.14 [95% CI, 1.07-1.22]; P < .001), even after adjusting for baseline comorbid conditions, individual components of the CHADS2 score, and warfarin treatment.Conclusion 
                  Among older patients admitted with recently diagnosed AF, the risk of stroke was greater in women than in men, regardless of warfarin use.
SN  - 0098-7484
M3  - doi: 10.1001/jama.2012.3490
UR  - http://dx.doi.org/10.1001/jama.2012.3490
ER  -