Background and Purpose-The information on the existence of sex differences in management of stroke patients is scarce.We evaluated whether sex differences may influence clinical presentation, resource use, and outcome of stroke in a European multicenter study. Methods-In a European Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin Scale). Results-Overall, 2239 patients were males and 2260 females. Compared with males, female patients were significantly older (mean age 74.5Ϯ12.5 versus 69.2Ϯ12.1 years), more frequently institutionalized before stroke, and with a worse prestroke Rankin score (all values PϽ0.001). History of hypertension (Pϭ0.007) and atrial fibrillation (PϽ0.001) were significantly more frequent in female stroke patients, as were coma (PϽ0.001), paralysis (PϽ0.001), aphasia (Pϭ0.001), swallowing problems (Pϭ0.005), and urinary incontinence (PϽ0.001) in the acute phase. Brain imaging, Doppler examination, echocardiogram, and angiography were significantly less frequently performed in female than male patients (all values PϽ0.001). The frequency of carotid surgery was also significantly lower in female patients (PϽ0.001). At the 3-month follow-up, after controlling for all baseline and clinical variables, female sex was a significant predictor of disability (odds ratio [OR], 1.41; 95% CI 1.10 to 1.81) and handicap (OR, 1.46; 95% CI 1.14 to 1.86). No significant gender effect was observed on 3-month survival. Conclusions-Sex-specific differences existed in a large European study of hospital admissions for acute stroke. Both medical and sociodemographic factors may significantly influence stroke outcome. Knowledge of these determinants may positively impact quality of care.

Background and Purpose-The role of atrial fibrillation (AF) as a determinant of stroke outcome is not well established.Studies focusing on this topic relied on relatively small samples of patients, scarcely representative of the older age groups. We aimed at evaluating clinical characteristics, care, and outcome of stroke associated with AF in a large European sample. Methods-In a European Concerted Action involving 7 countries, 4462 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin scale). Results-AF was present in 803 patients (18.0%). AF patients, compared with those without AF, were older, were more frequently female, and more often had experienced a previous myocardial infarction; they were less often diabetics, alcohol consumers, and smokers (all PϽ0.001). At 3 months, 32.8% of the AF patients were dead compared with 19.9% of the non-AF patients (PϽ0.001). With control for baseline variables, AF increased by almost 50% the probability of remaining disabled (multivariate odds ratio 1.43, 95% CI 1.13 to 1.80) or handicapped (multivariate odds ratio 1.51, 95% CI 1.13 to 2.02). Before stroke, only 8.4% of AF patients were on anticoagulants. The chance of being anticoagulated was reduced by 4% per year of increasing age. AF patients underwent CT scan and other diagnostic procedures less frequently and received less physiotherapy or occupational therapy. Conclusions-Stroke associated with AF has a poor prognosis in terms of death and function. Prevention and care of stroke with AF is a major challenge for European health systems. (Stroke. 2001;32:392-398.)