November 25, 2016European Heart Journal
Revisiting sex differences in outcomes in non-valvular atrial fibrillation: a population-based cohort study
Why the study?
Does female sex increase the risk of ischaemic stroke in patients with non-valvular atrial fibrillation?
Population
147,622 patients with non-valvular atrial fibrillation (NVAF) during 2000-2009 with RAMQ medication coverage
Comparison
Female sex vs Male sex
Design
Cohort
Follow-up
mean 2.9 years
Authors
Discussion
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Implication
Apparent higher stroke risk in women with non-valvular AF may reflect confounding; challenges prior findings and leaves open need for validation.
Key Points
- This research aims to clarify the association between sex and ischaemic stroke risk in non-valvular atrial fibrillation patients.
- Analyzed a cohort of 147,622 patients with non-valvular atrial fibrillation from 2000-2009 using RAMQ databases.
- Utilized Cox proportional hazards models for time-fixed covariate adjustments and a nested case-control design for time-dependent adjustments.
- Compared stroke, mortality, and bleeding rates between sexes over a mean follow-up of 2.9 years.
- Women showed a higher stroke risk than men with time-fixed adjustments (HR 1.16; 95% CI 1.11-1.21).
- No significant difference in stroke risk between sexes with time-dependent adjustments (Rate Ratio 1.01; 95% CI 0.97-1.05).
- Women had lower mortality and bleeding rates compared to men in both analyses.
Structured PICO
Does female sex increase the risk of ischaemic stroke in patients with non-valvular atrial fibrillation?
P
Population
147,622 patients with non-valvular atrial fibrillation (NVAF) during 2000-2009 with RAMQ medication coverage
I
Intervention
Female sex
C
Comparator
Male sex
O
Outcome
Ischaemic strokehard clinical
When accurately adjusting for age and time-dependent confounders, female sex is not associated with an increased risk of ischemic stroke in patients with non-valvular atrial fibrillation.
Cite This Study
Renoux et al. (2016) studied this question.