Optimized atrial fibrillation detection and anticoagulation could prevent approximately 33 strokes per 1,000 women and 28 strokes per 1,000 men annually due to higher thromboembolic risk in women.
Cohort (n=40,077)
Does optimized atrial fibrillation detection and oral anticoagulation prevent a different absolute number of strokes in women compared to men?
Women with incident atrial fibrillation present with older age and higher thromboembolic risk, meaning equitable detection and anticoagulation could prevent a greater absolute number of strokes in women despite their lower AF prevalence.
Absolute Event Rate: 33% vs 28%
Abstract Background and aims Sex-related differences in atrial fibrillation epidemiology and comorbidity profiles may influence the real-world potential for stroke prevention. This study examined the sex-specific risk distribution for incident AF and estimated the number of ischemic strokes potentially preventable through optimized AF detection and anticoagulation by sex. Methods A retrospective, community-based cohort of 40,077 adults aged 65–90 years was followed from 2015–2024. Incident AF (n = 3,370; 8.4%) was identified from electronic health records. Cardiovascular comorbidities, CHA₂DS₂-VASc and CHA₂DS₂-VA scores, and observed stroke incidence (per 100 person-years) were analyzed by sex. Preventable strokes were estimated assuming a 65% risk reduction from oral anticoagulation in eligible patients. Results Men (57.2%) showed higher AF incidence (9.9%vs7.0%) and greater prevalence of diabetes, coronary, and peripheral vascular disease. Women were older (80.9 ± 6.1 vs. 79.5 ± 6.2 years; p 0.001) and had more dyslipidaemia and cognitive impairment, leading to higher CHA₂DS₂-VASc scores (4.5 vs. 3.6; p 0.001). Based on population risk profiles, the estimated annual stroke incidence attributable to untreated AF was 5.1/100 person-years in women and 4.3/100 person-years in men. Applying anticoagulation efficacy, approximately 33 preventable strokes per 1,000 AF women and 28 per 1,000 AF men could be avoided annually Conclusions AF incidence and risk composition differ significantly by sex. Women present with older age and higher thromboembolic risk, suggesting that equitable AF detection and anticoagulation could prevent a greater absolute number of strokes among women, despite lower AF prevalence Conflict of interest ALL AUTHORS HAVE NOTHING TO DISCLOSE
Panisello-Tafalla et al. (2026) conducted a cohort in Incident atrial fibrillation (n=40,077). Optimized AF detection and oral anticoagulation vs. Untreated AF (estimated) was evaluated on Estimated preventable ischemic strokes per 1,000 AF patients annually (women vs men). Optimized atrial fibrillation detection and anticoagulation could prevent approximately 33 strokes per 1,000 women and 28 strokes per 1,000 men annually due to higher thromboembolic risk in women.