European Society of Cardiology thinks preventing strokes in women is too complicated

[NoBinturongsHereMate]

Atrial fibrillation causes a greater increase in stroke.risk in women than it does in men, so the scoring tool to assess risk adds a point for female sex.

Or it did.

The ESC has removed that question because: "the inclusion of gender [sic] complicates clinical practice both for healthcare professionals and patients" and "it also omits individuals who identify as non-binary, transgender, or are undergoing sex hormone therapy".

https://x.com/AudreySuffolk/status/1831279559930433813?

The option of adding a question for 'Undergoing sex hormone therapy?' and telling everyone else their feelings don't affect their stroke.risk apparently didn't occur to them.

FFS, don't they realise that women only exist to look after men and therefore it's important to make sure that we're not out of action from a stroke?

Glad that GI isn't detrimental to women

Another one.

Ffs. Hopefully some grownups will show up and include sex in their criteria, as it's relevant. 'Gender' certainly sounds like an unhelpful and unnecessary complication.

If hormone therapy affects the risk (whether it's males taking female hormones, females taking T or women on HRT then those should be specific questions.

Atrial fibrillation causes a greater increase in stroke.risk in women than it does in men, so the scoring tool to assess risk adds a point for female sex.

That's interesting. A friend who was referred to a specialist in this area was rejected by the lead consultant as she was past working age, ie as she was not contributing to the country's economy she didn't even make it onto the waiting list.

(Just to add this was NHS England.)

What?

Is that to my comment?

Yes...there may be some sort of priority based on age but that seems harsh?

Wait, was she offered any treatment for it? My mum got sent to a specialist at 70.

I think it goes on all the time, but usually you aren't told to your face by a consultant that they have an age cut off. (From memory there might have been a reference to something like it wasn't as though she was a working father or some such!)

But a while ago, and is probably still going on, some NHS trusts thought a good way of saving money, was to cut back on cataract operations (as they were mainly old / retired patients) not taking into account that untreated cataracts can lead to total visual impairments so that in fact these pensioners would become more dependent on the state! (Also stupid as they are relatively cheap operations to perform.)

Not forgetting all the patients of a certain age and over who were sent DNR forms duing Covid by their local surgery!

Apolgies, for thread derail.

One of my aunts moved to part-time in advance of her retirement so that she can provide reliable childcare for her grandchild and reduce childcare costs for her DS.

I should think so many people of a certain age are in a comparable condition.

And maybe it's a failure of imagination, but I just can't imagine this being said to a man.

Wait, was she offered any treatment for it? My mum got sent to a specialist at 70.

If memory serves me right, when her immediate doctor who made the referral checked up on the progress of her treatment, found out what had happened then referred her to another hospital. And then there was Covid.

The problem may have been that the first hospital was said to be THE specialists, and were getting too many referrals. But if that was the case would have been more acceptable to say they can only take referrals from their catchment area.

I only know about this because her response to such an overt case of age (and sex?) discrimination was on one level to just laugh as it confirmed everything some of us know about how women are treated. But also worry of course. The potential for a stroke lurking there every day.

I've only skimmed this but I think this is the link to the published guidelines

academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae176/7738779?login=false

The problem here is that men are 3 x more likely to have a stroke under 75. Women, while they have a higher risk, it’s over 75. While yes AF is a risk factor it isn’t one in women under 70.

@ozanj

Was this the case though?

Atrial fibrillation causes a greater increase in stroke.risk in women than it does in men, so the scoring tool to assess risk adds a point for female sex.

What?! They actually said that? Appalling doesn't even begin to cover it.

"I only know about this because her response to such an overt case of age (and sex?) discrimination was on one level to just laugh as it confirmed everything some of us know about how women are treated."
This is what I too easily default to, and why I value FWR so much.

From the guidelines linked above:

Across Europe, the most popular risk score is CHA2DS2–VASc, giving points for congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, prior stroke/TIA/thromboembolism (2 points), vascular disease, age 65–74 years and female sex. However, implementation has varied in terms of gender. Female sex is an age-dependent stroke risk modifier rather than a risk factor per se.112,256,257 The inclusion of gender complicates clinical practice both for healthcare professionals and patients.258 It also omits individuals who identify as non-binary, transgender, or are undergoing sex hormone therapy. Previous guidelines from the ESC (and globally) have not actually used CHA2DS2-VASc; instead providing different score levels for women and men with AF to qualify for OAC. Hence, CHA2DS2-VA (excluding gender) has effectively been in place (Table 10).78 This task force proposes, in the absence of other locally validated alternatives, that clinicians and patients should use the CHA2DS2-VA score to assist in decisions on OAC therapy (i.e. without a criterion for birth sex or gender). Pending further trials in lower risk patients (NCT04700826,259 NCT02387229260), OAC are recommended in those with a CHA2DS2-VA score of 2 or more and should be considered in those with a CHA2DS2-VA score of 1, following a patient-centred and shared care approach. Healthcare professionals should take care to assess for other thromboembolic risk factors that may also indicate the need for OAC prescription.

Refs for age and sex as raised by Ozanj

The female/male ischaemic stroke risk ratio varied with age. Only women aged >75 years had a higher risk, whereas women aged <65 years had a lower risk compared with men. These findings challenge the ‘sex category’ component of the CHA2DS2-VASc score, used to make decision regarding anticoagulation treatment in AF patients.
Wu VC, Wu M, Aboyans V, et al
Female sex as a risk factor for ischaemic stroke varies with age in patients with atrial fibrillation
Heart 2020;106:534-540.
https://doi.org/10.1136/heartjnl-2019-315065

Female sex was only associated with an increased risk of stroke for AF patients aged ≥ 75 years. Our study suggests that female sex should not be automatically included as an independent stroke/thromboembolic risk factor in guidelines or in the CHA2DS2‐VASc score, without careful prior consideration of the ‘age < 65 and lone AF’ criterion.
Female sex as a risk factor for stroke in atrial fibrillation: a nationwide cohort study
MIKKELSEN, A.P. et al. Journal of Thrombosis and Haemostasis, Volume 10, Issue 9, 1745 - 1751
https://doi.org/10.1111/j.1538-7836.2012.04853.x

It would be simple enough to make 'female sex' female sex + age over 75' if the goal is to improve accuracy.

The fact they are calling it gender and wibbbling about excluding non-binary identities shows their goal is not improved simplicity or accuracy.

I can't find those figures, do you have a source for them, please? I've seen several organisations state this:

By the age of 75, 1 in 5 women and 1 in 6 men will have a stroke.

https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2016_110116_0.pdf

There are fluctuations in risk across lifetime, however, this is a general age-related point and not specific to ischaemic stroke.

Recent evidence suggests that young women (18–45 years) may be at higher risk of ischemic strokes than men of the same age. The goal of this systematic review is to reconcile and synthesize existing evidence of sex differences among young adults with ischemic strokes.
…
Overall, there were 44% more women ≤35 years with ischemic strokes than men. This gap narrows in young adults, 35 to 45 years, and there is conflicting evidence whether more men or women have ischemic strokes in the 35 to 45 age group.

Systematic Review of Sex Differences in Ischemic Strokes Among Young Adults: Are Young Women Disproportionately at Risk?
Author:
Michelle H. Leppert, James F. Burke, Lynda D. Lisabeth, Tracy E. Madsen, et al.
Publication:
Stroke
Publisher:
Wolters Kluwer Health, Inc.
Date:
Jan 24, 2022

https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.037117

Yes. Stroke risk due to AF is only for women over 75. Read the guidelines.

No, I mean did they add a point in the past as described , and why did they do that? @Ozanj - it's a genuine question, was the risk model based on now outdated research?

WTF? Medics are rotten at doing research on and dealing with women and now they can't even be bothered to mention us on the scale? Gahhh come the Glorious Revolution I have my list for first up against the wall, and I'm going to need a very long wall 🤯

Yeah, there's the klaxon, right there.