Canadian women who have suffered a stroke are more likely to die, less likely to be able to return home from the hospital and generally face worse outcomes than men, according to a new Heart & Stroke report that says urgent change is required to help women understand the unique stroke risks they face – and to get them the help they need.
According to the report, women represent nearly 60 per cent of all deaths due to stroke in Canada, and represent less than half of all stroke rehabilitation patients. And women are 60 per cent less likely than men to regain independence in their daily activities following a stroke.
Some of the discrepancies are due to the fact that women live longer than men and tend to suffer strokes when they are older and are dealing with other health conditions that could complicate recovery. But many of the reasons behind these sex-based differences are just beginning to emerge, and much more research is needed to fully understand the implications, said Patrice Lindsay, Heart & Stroke’s director of stroke.
“We don’t understand the whys yet,” she said in an interview.
For instance, because women tend to have stroke at older ages, it’s more likely they will be living alone and won’t have access to support or care once they are discharged. That’s one of the reasons why many older women tend to end up in long-term care homes after a stroke, Dr. Lindsay said.
Women are also under-represented in clinical trials and other research involving stroke. Dr. Lindsay noted that this isn’t necessarily because they are purposefully excluded. But women may be less likely to participate in trials for a number of reasons, such as family obligations or unwillingness to try a new medication.
Researchers also need to figure out why women are more likely to die after a stroke. Part of the reason could be a general lack of awareness of stroke symptoms, such as drooping face, inability to raise both arms or slurred speech. According to the report, only 60 per cent of women know what a stroke is and only 36 can recognize the key symptoms. Delay in seeking treatment can greatly impact stroke recovery, as the loss of blood flow results in rapid brain-cell death.
Other factors are also at play. Atrial fibrillation is an irregular heart rhythm that can lead to a number of serious consequences, including stroke. Women are about 15 per cent more likely to have atrial fibrillation when they are admitted to a hospital for a stroke treatment. That’s typically because they tend to be older than male patients and risk of atrial fibrillation increases with age. Despite this, the report found that women with atrial fibrillation are often prescribed weaker blood thinners than men and are less likely to have other treatments to improve their symptoms. The report says less than 1 per cent of women know atrial fibrillation is a stroke risk factor.
“It’s a key sort of public-health crisis,” said Jodi Edwards, director of the Brain and Heart Nexus Research Program at the University of Ottawa Heart Institute.
Stroke is more likely among older women, especially after the age of 75. But younger women also face elevated risks, particularly during pregnancy and after menopause, when the use of hormone-replacement therapy increases.
Julie Tomaino learned the hard way about the risks of stroke in women. One day last April, the then-38-year-old Toronto resident suddenly had a hard time seeing and went to the hospital. The doctors couldn’t find anything wrong and chalked it up to a panic attack. Later that night, she began vomiting and had a severe headache. She returned to the hospital with her husband and it was there that she had several strokes that would leave her “locked in” for a week – unable to move or speak – and would change her life.
"I couldn't have foreseen this happening," Ms. Tomaino said.
It’s unclear why she had a stroke. And within a few months, she had made a remarkable recovery, learning to walk, talk and perform everyday functions again. She has since returned to work full-time as a choreographer and dance instructor.