Sex-Related Differences of Acute Stroke Unit Care

Abstract

Background and Purpose-Sex-related differences in quality of acute stroke care are an important concern with limited data available, specifically regarding stroke unit (SU) setting. We used the prospective nationwide Austrian SU registry to address this issue. Methods-Our analysis covered an 8-year time period (January 2005 to December 2012) during which all patients with transient ischemic attack or ischemic stroke admitted to 1 of 35 Austrian SU had been captured in the registry. These data were analyzed for age-adjusted preclinical and clinical characteristics and quality of acute stroke care in men and women. In addition, we assessed the outcome at 3 months in multivariate analysis. Results-A total of 47 209 individuals (47% women) had received SU care. Women were significantly older (median age:77.9 versus 70.3 years), had higher pre-existing disability and more severe strokes. Correcting for age, no significant sex-related differences in quality of care were identified with comparable onset-to-door times, times to and rates of neuroimaging, as well as door-to-needle times and rates of intravenous thrombolysis (14.5% for both sexes). Despite equal acute stroke care and a comparable rate of neurorehabilitation, women had a worse functional outcome at 3-month follow-up (modified Rankin scale 3-5: odds ratio,

Sex-Related Differences in Management and Outcome of Acute Ischemic Stroke in Eligible Patients to Thrombolysis

“…Three-month mortality was similar between women and men (17.24 vs. 16.72%, p = 0.8751) in age-adjusted groups but remained nonsignificant as in Kapral [19] (14 vs. 12%, p = 0.1897) of 6-month mortality in stroke population at acute care. Conversely, Gattringer et al [20] indicated on a transient ischemic attack or ischemic stroke admitted that 3 months after the cerebrovascular event, women had a higher mortality and a worse functional outcome. Also, after adjustment of confounding factors, Lorenzano et al [21] suggested a possible larger beneficial effect of intravenous tPA in women compared with men due to a 3-month mortality higher for men com- [20] and that women had a higher burden of AF [16], we found that this etiology is associated with 3-month mortality in women (RR 2.38 [1.28-4.43], p = 0.0060), whereas this risk factor was not significant in men (p = 0.3100).…”

Inhibition of Mitochondrial P53 Abolishes the Detrimental Effects of Social Isolation on Ischemic Brain Injury

“…Large gaps still remain in our understanding of the mechanism underlying these sex disparities 2,4 . Early reports suggested that women were less likely than men to receive appropriate care after an acute stroke, but these gender gaps are closing 5 . Despite equivalent care, women continue to have poorer functional outcomes compared to age matched males 5 .…”

“…Early reports suggested that women were less likely than men to receive appropriate care after an acute stroke, but these gender gaps are closing 5 . Despite equivalent care, women continue to have poorer functional outcomes compared to age matched males 5 . Importantly, women are 3.5 times more likely than men to be widowed and living alone at the time of their stroke and it this lack of social support and the higher prevalence of depression could be the important contributing factors to the poorer recovery in women 2,4 .…”

Stroke Referrals from Nursing Homes: High Rate of Mimics and Late Presentation

“…The high mean age of our NH residents (frequent occurrence of dementia) with a high prevalence of concomitant polypharmacy (metabolic disorders due to medication side effects/interactions) as well as confined living arrangements in NH (infections) may have played a significant role in the development of these typical stroke mimicking conditions [11-16]. Higher age (78 vs. 74 years) and a large female preponderance (72 vs. 47%) are evident when comparing a collected group of NH residents with the overall stroke population as documented in the Austrian stroke unit registry [10]. …”