Peter M. Hannon, MD
Gattringer T, Ferrari J, Knoflach M, Seyfang L, Horner S, Niederkorn K, et al. Sex-Related Differences of Acute Stroke Unit Care: Results From theAustrian Stroke Unit Registry. Stroke. 2014
Over the last decade, a number of studies have investigated gender disparities in stroke etiology, care and outcomes. Authors Gattringer et. al. have utilized a nationwide Stroke Unit registry in Austria to explore some of these potential disparities. From 2005-2012, 47,209 patients (47% women) were identified who were admitted and worked up for acute ischemic stroke (AIS) and TIA at specialized Stroke Unit facilities throughout Austria.
Authors found that women admitted were significantly older (77.9 vs. 70.3 yrs), had higher preexisting disability and more severe strokes (median NIHSS 4 vs 3) at admission. Correcting for age, there was no significant sex-related difference in onset-to-door times, times to and rates of neuroimaging, door to needle times and rates of IV tPA administration (14.5% for both sexes). After taking into account multiple potential clinical confounders including age, stroke severity and preexisting disability, authors found that female stroke patients had a higher rate of disability, dependency and need of permanent nursing after 3 months, but lower mortality rate. While acute stroke care seemed equitable among men and women, authors did find that despite a significantly higher of diagnosed atrial fibrillation among female patients, there was no difference in the rates of anticoagulation use at follow-up, suggesting under-treatment at discharge.
Follow-up rates were relatively low (40%), yet this study reaffirms prior findings of worse disability in female stroke patients after discharge as compared to men, and more importantly, does so in the setting of apparent equitable acute stroke care and comparable rates of neurorehabilitation. Clearly there are forces at work that cause our female stroke patients to have worse functional outcomes after discharge, such as weaker social support and older or deceased spouses. Knowing this, what steps can we take to help improve outcomes in this population? From this study at least, a good place to start may be taking a hard look at the care, support system and comorbidities of our female stroke patients, especially after discharge.