Arrhythmias & electrophysiology

Trends in stroke risk among female and male patients with atrial fibrillation: A 20-year population-based cohort study

Heart RhythmPublished population-based retrospective cohort study

Authors' conclusion

While the point estimates suggest a gradual attenuation in the excess stroke risk among females over time, no statistically significant temporal trend was observed.

Study context

Population
Nonanticoagulated patients with newly diagnosed nonvalvular atrial fibrillation (AF) between 2004 and 2023, database of the largest health care provider in Israel57,951 (51.5%) females
Participants
112,478 patients
Exposure
The 1-year cumulative incidence function of female patients with that of male patients
  • Femalesn = 57,951
Outcome
Age

Main finding

As reported in the abstract

Observational data: associations, not effects.

Further findings

OutcomeRelative risk (95% CI)
Stroke (ischemic stroke or systemic embolism), CHA2DS2-VA score-adjusted, by period · 1-yearFemalesvs males2004-2007 · pseudo-value approach1.16 (0.85–1.57)
Stroke (ischemic stroke or systemic embolism), CHA2DS2-VA score-adjusted, by period · 1-yearFemalesvs males2008-2011 · pseudo-value approach1.20 (0.92–1.57)
Stroke (ischemic stroke or systemic embolism), CHA2DS2-VA score-adjusted, by period · 1-yearFemalesvs males2012-2015 · pseudo-value approach1.29 (1.01–1.64)
Stroke (ischemic stroke or systemic embolism), CHA2DS2-VA score-adjusted, by period · 1-yearFemalesvs males2016-2019 · pseudo-value approach1.06 (0.85–1.32)
Stroke (ischemic stroke or systemic embolism), CHA2DS2-VA score-adjusted, by period · 1-yearFemalesvs males2020-2023 · pseudo-value approach0.99 (0.79–1.23)

1-year crude cumulative incidence of stroke

Females consistently had a higher 1-year crude cumulative incidence of stroke, with both sexes showing an increase over time followed by a recent decline, peaking earlier in females

Original publication

Trends in stroke risk among female and male patients with atrial fibrillation: A 20-year population-based cohort study. Heart Rhythm. Published 30 June 2026. doi:10.1016/j.hrthm.2026.06.028

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