Background: Atrial fibrillation (AF) related Thromboembolic events result in significant morbidity and mortality. There are controversial data of the different prognosis of men and women with AF. Female gender is incorporates in the recent CHA2DS2-VASC risk score. The aim of the present study was to assess the risk of stroke, bleeding and death in men and women with AF.
Methods: A prospective historical cohort study, conducted using the Clalit Health Services Research Institute (CHRI) database, between 2004 and 2011. All patients with new incident AF incidence were followed. Primary endpoints were cerebro-vascular ischemic stroke, death and major bleeding.
Results: We identified 98,811 patients with new onset non-valvular AF. Among those patients, 49,275 (49.8%) were women and 49,536 (51.2%) were men. Mean follow-up time was 48.8 months. Women were older (average age 74 vs.70), had a higher prevalence of hypertension but lower prevalence of diabetes, congestive heart failure and ischemic heart disease. Incidence rates of ischemic stroke were identical, 5.3% for both genders (p=0.62). Factors associated with increased stroke risk were previous CVA, age > 65, hypertension, congestive heart failure and diabetes. All-cause mortality was higher among women (37.8% vs. 36.1%). Adjusted death risk was associated with male gender, age over 65, previous stroke or MI and diabetes. Intra-cerebral bleeding occurred for 1% of men and 0.9% of women. Bleeding incidence was higher among VKA users (1.4% vs. 0.8%). Gastrointestinal bleeding rates were 2.8% for men and 2.2% for women (3.4% among VKA users vs. 2.1%).
Conclusion: In this large contemporary study of patients with AF, the risk of ischemic stroke was similar in men and women. For both men and women, risk factors for stroke or mortality were similar. We suggest a similar anti-coagulation strategy in men and women with AF over the age of 65.
