Abstract TMP67: Sex Disparities in Atrial Fibrillation as a Predictor of Poor Discharge Disposition After Ischemic Stroke Hospitalization: The Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study
Background: It is unknown whether atrial fibrillation (AF) is responsible for increased morbidity and disability seen in women with ischemic stroke. We sought to determine whether patients with ischemic stroke and AF had poorer outcomes than ischemic stroke patients without AF and whether this effect is more pronounced among women.
Methods: We analyzed data from the FL-PR CReSD Study, a large quality improvement registry of Florida (N=66) and Puerto Rico (N=9) hospitals based on the Get With The Guidelines-Stroke (GWTG-S) program. Discharge disposition was utilized as a surrogate marker for morbidity and disability, with discharge to home or rehabilitation in comparison to other discharge dispositions (skilled nursing facility, hospice or died). Multilevel generalized linear models were used to evaluate AF and sex disparities in discharge disposition adjusted for demographics, risk factors (hypertension, diabetes, heart failure, previous stroke/TIA), and NIHSS and CHADS2 scores.
Results: We examined a total of 55,945 ischemic stroke patients, of whom 11,797 (21%) had AF at discharge. AF patients were older than non-AF patients (79.0±10.9 years vs. 68.7±14.4 years), had higher proportion of women (54% vs. 49%) and more severe strokes (mean NIHSS 10±9 vs. 7±7). Among AF patients, women were older (81±10 vs. 76±11 years) and had greater NIHSS (11±9 vs. 9±8) and CHADS2 scores (3.9±0.9 vs. 3.7±1.0) than men. Overall, AF patients were less likely discharged to home or rehabilitation than those without AF (54% vs. 71%, OR 0.93, 95% CI 0.89-0.98). There was a significant effect modification between AF and discharge disposition by sex. In stratified analyses by sex, AF was associated with less discharged to home or rehabilitation among women (OR 0.85, 95% CI 0.79-0.91), but not among men (OR 1.04, 95% CI 0.96-1.11).
Conclusion: Women with AF were less likely discharged to home or rehabilitation facility after ischemic stroke. Baseline differences in age, stroke severity, risk factors, and comorbidities between men and women had little impact on the poorer outcome and discharge disposition after ischemic stroke in women. Further studies are warranted to identify the causes of sex-specific differences in stroke outcomes for patients with AF.
Author Disclosures: R.C. Martin: None. D.Z. Rose: Speakers' Bureau; Modest; Boehringer Ingelheim Pharmaceuticals, Inc. (PRADAXA®, dabigatran etexilate), 2013-current, Chiesi-USA (prior Cornerstone Therapeutics) (CARDENE IV ®, Nicardipine), 2013-current. K. Wang: None. M.A. Ciliberti-Vargas: None. J.G. Romano: Research Grant; Modest; Research salary support to Department of Neurology at the University of Miami from Genentech (for role as PI of the Mild and Rapidly Improving Stroke Study (MaRISS),, Core B PI of the FL-PR CReSD (SPIRP) (U54 NS-081763). Consultant/Advisory Board; Modest; Genentech (for Steering Committee role of the Potential for rtPA to Improve Stroke with Mild Symptoms (PRISMS) Study), Vycor/NovaVision (for Scientific Advisory Board role). C. Dong: Research Grant; Modest; Co-I of the FL-PR CReSD (SPIRP) (U54 NS-081763). N. Asdaghi: None. S. Koch: Research Grant; Modest; Core B Co-I of the FL-PR CReSD (SPIRP) (U54 NS-081763). S.P. Waddy: Employment; Significant; This work was sponsored by the National Institutes of Health (NIH), and I am the Project Scientist representing the NIH. M. Robichaux: None. M.F. Waters: None. R.L. Sacco: Research Grant; Modest; PI of the FL-PR CReSD (SPIRP) (U54 NS-081763). Consultant/Advisory Board; Modest; Boehringer Ingelheim consultant for secondary stroke prevention trial with Dabigatran. T. Rundek: Research Grant; Modest; Core C PI of the FL-PR CReSD (SPIRP) (U54 NS-081763). W.S. Burgin: Research Grant; Modest; Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-II: A Phase III Randomized Multicenter Clinical Trial of Blood Pressure Reduction for Hypertension in Acute Intracerebral Hemorrhage. Cl, A Phase 3, Randomized, Placebo-Controlled, Double-Blind Study of the Combined Lysis of Thrombus with Ultrasound and Systemic Tissue Plasminogen Activator (tPA) for Emergent Revascularization (CLOTBUST, A Randomised, Double-Blind, Multinational Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin (ASA) in Patients with Acute Ischaemic Stroke or TIA [SOCRATES –Acute Stroke Or Tra.
- © 2016 by American Heart Association, Inc.