Caring Currents

Heart Health Alert: Higher Stroke Risk for Women With Atrial Fibrillation

Last updated: Sep 30, 2009

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Women with atrial fibrillation are significantly more likely to have a stroke or die than are men with the same condition, announced researchers at Rush University Medical Center after conducting a review of data from all the available studies.

Yet, despite the fact that they're more likely to have strokes, women with atrial fibrillation are less likely than men to receive medical attention. Talk about a double whammy.

Atrial fibrillation is one of the most common heart conditions in older adults, affecting 22 million people. It occurs when the two small upper chambers of the heart, called the atria, quiver rather than beat effectively, which causes blood to pool and clot. The clots can then cause strokes if they travel to an artery in the brain.

Rush University Medical Center researchers reviewed past studies and medical literature and found that women with atrial fibrillation are more likely than men to experience symptomatic attacks and have recurrences, and that women have significantly higher heart rates during atrial fibrillation, which increases the risk for stroke.

The take-home message from the lead researcher, Annabelle Volgman, medical director of Rush's Heart Center for Women was stark: "Women are at higher risk of atrial fibrillation-related stroke than men and are more likely to live with stroke-related disability, which can significantly lower quality of life," she says. Her announcement came based on a review of 20 years of studies examining gender differences in atrial fibrillation. What these studies show is that because of the elevated risk, women need additional prevention and treatment efforts to stave off afib and then manage it safely once it occurs.

7 Key Stroke-Prevention Strategies for Women with Atrial Fibrillation:

1. Blood Thinners. Women are not prescribed blood thinners as often as men, resulting in a higher incidence of clots that break loose and block other vessels.

2. Monitoring for Bleeding. Women have a greater risk of bleeding from anticoagulation therapy, so while anticoagulants are warranted for many women, they must be monitored carefully.

3. Arrhythmia. Women have a higher risk of life-threatening arrhythmias and slow heart rates. This means they may need pacemakers, requiring permanent pacing when treated with antiarrhythmic drugs. Monitor female patients taking antiarrhythmia drugs carefully.

4. Statins and Vasodilators. Women have a higher sensitivity to statin drugs and vasodilators. So kidney and liver functions need to be closely monitored if doctors prescribe these drugs.

5. Hormonal fluctuations. Because hormonal fluctuations during the normal menstrual cycle can cause more life-threatening arrhythmias.

6. Low Potassium. Women have a higher risk of low potassium levels in the blood, and low potassium increases the risk of drug-related arrhythmias. This means women need their serum and potassium levels carefully monitored.

7. Ablation and Pacemakers (Non-Drug Therapies). Women are referred less often or later for non-drug treatment options such as radiofrequency ablation and having a pacemaker implanted. These treatments have similar success rates in women as in men. In fact, radiofrequency ablation and pacemaker monitoring may be even better options in women because of the risk factors for medication-based treatments.

Sadly, the study's ultimate conclusion was that women living with atrial fibrillation have a lower quality of life than men with the disease.

But they also made it clear it doesn't have to be this way. The problems are directly related to the fact that women aren't being effectively treated. With careful assessment and relief of symptoms and adequate control of heart rate and rhythm, the researchers said, women's health and quality of life should be equal to men's.