Open AccessField Synopsis of the Role of Sex in Stroke Prediction Models
Author(s) -
Paulus Jessica K.,
Lai Lana Y. H.,
Lundquist Christine,
Daneshmand Ali,
Buettner Hannah,
Lutz Jennifer S.,
Raman Gowri,
Wessler Benjamin S.,
Kent David M.
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.002809
Subject(s) - medicine , stroke (engine) , odds ratio , incidence (geometry) , population , female sex , odds , physical therapy , logistic regression , mechanical engineering , physics , environmental health , optics , engineering
Background Guidelines for stroke prevention recommend development of sex‐specific stroke risk scores. Incorporating sex in Clinical Prediction Models ( CPM s) may support sex‐specific clinical decision making. To better understand their potential to guide sex‐specific care, we conducted a field synopsis of the role of sex in stroke‐related CPM s. Methods and Results We identified stroke‐related CPM s in the Tufts Predictive Analytics and Comparative Effectiveness CPM Database, a systematic summary of cardiovascular CPM s published from January 1990 to May 2012. We report the proportion of models including the effect of sex on stroke incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 92 stroke‐related CPM s, 30 (33%) contained a coefficient for sex or presented sex‐stratified models. Only 12/58 (21%) CPM s predicting outcomes in patients included sex, compared to 18/30 (60%) models predicting first stroke ( P <0.0001). Sex was most commonly included in models predicting stroke among a general population (69%). Female sex was consistently associated with reduced mortality after ischemic stroke (n=4) and higher risk of stroke from arrhythmias or coronary revascularization (n=5). Models predicting first stroke versus outcomes among patients with stroke (odds ratio=5.75, 95% CI 2.18–15.14, P <0.001) and those developed from larger versus smaller sample sizes (odds ratio=4.58, 95% CI 1.73–12.13, P =0.002) were significantly more likely to include sex. Conclusions Sex is included in a minority of published CPM s, but more frequently in models predicting incidence of first stroke. The importance of sex‐specific care may be especially well established for primary prevention.