Do Women With Atrial Fibrillation Experience More Severe Strokes? Results From the Austrian Stroke Unit Registry.
Ischemic strokes associated with atrial fibrillation (AF) are more severe than those of other cause. We aim to study potential sex effects in this context.



In this cross-sectional study, 74 425 adults with acute ischemic stroke from the Austrian Stroke Unit Registry were included between March 2003 and January 2016. In 63 563 patients, data on the National Institutes of Health Stroke Scale on admission to the stroke unit, presence of AF, vascular risk factors, and comorbidities were complete. Analysis was done by a multivariate regression model.



Stroke severity in general increased with age. AF-related strokes were more severe than strokes of other causes. Sex-related differences in stroke severity were only seen in stroke patients with AF. Median (Q25,75) National Institutes of Health Stroke Scale score points were 9 (4,17) in women and 6 (3,13) in men (P<0.001). The interaction between AF and sex on stroke severity was independent of age, previous functional status, vascular risk factors, and vascular comorbidities and remained significant in various subgroups.



Women with AF do not only have an increased risk of stroke when compared with men but also experience more severe strokes.
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Clemens
C
Lang
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Leonhard
L
Seyfang
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Julia
J
Ferrari
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Thomas
T
Gattringer
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Stefan
S
Greisenegger
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Karin
K
Willeit
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Thomas
T
Toell
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Stefan
S
Krebs
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Michael
M
Brainin
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Stefan
S
Kiechl
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Johann
J
Willeit
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.).
Wilfried
W
Lang
From the Department of Neurology, Hospital St. John of God, Vienna, Austria (C.L., J.F., S. Krebs, W.L.); Austrian Institute for Health Care (Österreichisches Bundesinstitut für Gesundheitswesen), Vienna, Austria (L.S.); Department of Neurology, Medical University of Graz, Austria (T.G.); Department of Neurology, Medical University Vienna, Austria (S.G.); Department for Clinical Neurosciences, Danube University, Krems, Austria (M.B.); Department of Neurology, Medical University of Innsbruck, Austria (K.W., T.T, S. Kiechl, J.W., M.K.); and Medical Faculty, Sigmund Freud University, Vienna, Austria (W.L.). Michael.knoflach@i-med.ac.at.
Michael
M
Knoflach
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D001317:Austria; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012727:Sex Characteristics; D020521:Stroke / Q000209:etiology*
atrial fibrillation; female; risk factors; sex; stroke