Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

Abstract

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

Stroke in the adult Qatari population (Q-stroke) a hospital-based retrospective cohort study

“…Additionally, a recent study [ 51 ] hypothesized that maybe poststroke depression and isolation could be a contributing factor for the poor short term outcomes observed in Qatari females, however, this requires more in-depth research.…”

“…This could be due to availability of household help, unavailability of socially acceptable fitness establishments and the desert climate [50]. Additionally, a recent study [51] hypothesized that maybe poststroke depression and isolation could be a contributing factor for the poor short term outcomes observed in Qatari females, however, this requires more in-depth research.…”

Major cardiovascular events in patients presenting with acute stroke: a 5-year follow-up study in patients who had ischaemic stroke and stroke mimics

“…However, during long-term follow-up, men tend to have higher MACE, especially in the presence of previous coronary artery disease. 11 The primary objective of the present research is to evaluate the short-term and long-term prognosis of AS and stroke mimic patients in an ethnically distinct Arab population in Qatar. We investigated the outcomes in patients who had an acute IS in the presence and absence of previous CVD and similarly in SM with and without previous CVD.…”

“…However, during long-term follow-up, men tend to have higher MACE, especially in the presence of previous coronary artery disease. 11 …”

How appropriate is use of antiplatelet medications in patients with transient ischemic attacks and stroke: an analysis of 9132 patients over eight years

“…We excluded patients in whom the final diagnosis was either ICH or stroke mimics. The details of the stroke database have previously been published (22)(23)(24)(25)(26)(27). In brief, HGH is a Joint Commission International accredited 600-bed hospital, where ~95% of all strokes in Qatar requiring hospitalization are admitted.…”