Medical Management in Patients following Stroke and Transitory Ischemic Attack: A Comparison between Men and Women

Abstract

Study Objective: Differences between men and women in management and outcome following cerebrovascular events have been described. However, most of the differences observed have only been partially adjusted for baseline differences, or not at all. The objective of the present study was to compare acute and follow-up management between men and women after stroke and transitory ischemic attacks, adjusting for potential confounders. Design: Patients with symptoms of stroke were included at admission to one of four participating hospitals in the inner city of Berlin, Germany. Risk factors, clinical characteristics, and acute management were assessed from medical records. Patients were asked about socioeconomic factors and follow-up management in a baseline interview and by postal questionnaire, respectively. The follow-up was 12 months. Multiple logistic regression analyses were used to assess odds ratios for management variables. Results: A total of 558 patients were included (55% men, mean age 65 ± 13 years; 45% women, 69 ± 14 years). Indications for admission were stroke (74%) and transitory ischemic attacks (26%). In multivariable analyses, there were no differences in diagnostic procedures performed at baseline and in follow-up management between men and women. However, women were significantly more likely to receive hypoglycemic drugs (odds ratio 2.49; 95% confidence interval 1.33–4.63) in the acute management period. Regarding the need for nursing support/a nursing home after 12 months, there were no significant differences between men and women. Conclusions: After adjustment for differences in baseline characteristics, we only found few differences in acute and long-term management between men and women following hospital admission after suffering a cerebrovascular event.

Decrease in the Stroke Case Fatality Rates in a French Population-Based Twenty-Year Study

“…The higher prevalence of risk factors such as HT, AF, obesity, diabetes, inactivity or poor nutrition are well known in women [15,16,17] but we observed no significant differences between men and women. We cannot argue that changes in risk factor prevalence may explain the decrease in case fatality rates because these changes did not involve the incidence rates.…”

“…Some differences between men and women were reported in the literature [2,15,16,17,18]. These differences may reflect differences in competing causes of death, socioeconomic status and other factors influencing death rates, such as lack of health insurance and lack of knowledge about the early warning signs of stroke.…”

Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital

“…1,2 We observed no gender difference in the majority of outcomes after adjusting for confounding variables. However, despite controlling for age, prestroke functional status, stroke subtype, AF, and stroke severity, women were less likely to have an excellent outcome (BI Ն95), confirming the findings of others.…”

“…ome studies of gender differences in the management of acute stroke have shown that women are investigated less thoroughly 1,2 and treated less frequently with antiplatelet agents 3 and tissue plasminogen activator (tPA). 4,5 The explanation for these findings is not clear but may relate to gender differences at presentation such as age, comorbidity, prestroke functional status, and stroke severity.…”

“…Other studies, however, demonstrate no gender differences in the use of investigation or treatment with tPA or antiplatelet agents. 2,6 Stroke incidence rates are lower for women across all age groups, 7 although women experience worse outcomes, 1,3,6 comprising 61% of stroke-related deaths in the United States. 8 Given these observations, we sought to determine among patients admitted to our stroke program whether there were any gender differences in the use of investigations, use of intravenous tPA, enrollment in clinical trials, and outcomes that were independent of confounding variables.…”