Female-specific risk factors and non-typical symptoms are being missed, meaning women are less likely than men to receive timely treatment.
Australian-led research has found that women were 11% less likely to be correctly identified as having a stroke than men.
Given that the efficacy of intravenous thrombolysis (IVT) is greatest when administered in the first hour, and patients are typically only eligible to receive it within about four hours of stroke onset, researchers say that timely pre-hospital stroke identification is critical.
Using NSW patient data from the 2020-2021 financial year, the researchers modelled stroke detection accuracy in women equal to that of men. Their findings have been published in the Medical Journal of Australia.
Nearly 7500 stroke hospitalisations were reported in women aged 18-64 years during that time.
They estimated both the potential increase in years of life and quality-adjusted life years (QALYs), as well as the financial benefits of improving stroke identification and pre-hospital management in women.
The study showed that women would gain an average of 51 extra days of life, more than half of which would be spent in good health.
The healthcare cost savings were estimated at nearly $3000 per patient.
Researchers equated this to more than 250 years lived, 144 extra QALYs and $5.4 million saved nationally for that financial year.
They recommended routine clinical inquiry about sex-specific stroke risk factors in patients, as well as standardising diagnostic approach, to reduce sex differences in stroke investigation and care.
Professor Seana Gall, epidemiologist with the University of Tasmania, told media that several female-specific risk factors existed, such as hypertensive disorders of pregnancy, gestational diabetes and a history of migraine.
She also highlighted the importance of recognising stroke risk in women of all ages.
“The risk is not static – women are at a relatively higher risk of stroke at certain points in their life particularly around pregnancy and post-partum and through the menopause transition,” she said.
She explained that stroke risk may be reduced in women with these risk factors through early intervention for other risk factors such as high blood pressure.
Professor Gall said that women may not conform to FAST and were more likely than men to present with additional symptoms such as headache, confusion, nausea or fatigue.
“Women with stroke presenting with these other signs may be missed, leading to delayed diagnosis,” she said.
Sex differences in both the risk and presentation of stroke were important for health professionals and the community to be aware of, she said.
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Using 2022 and 2023 data from the Australian Stroke Clinical Registry, the model assumed that 83% of these strokes were ischaemic and would benefit from timely IVT, and that less than 30% received treatment within the optimal 60-minute window.
Patients with inaccurate stroke identification entered the model of usual care, including aspirin, a statin and an antihypertensive medication when indicated.
In patients correctly diagnosed, they entered the model of having received timely IVT.
Patients who survived the first three months following a stroke entered a model to evaluate healthcare costs and health outcomes over the following 50-year period.
In each 12-month window, patients were assessed for death or a worsened health state due to recurrent stroke, death from background mortality or remaining in the same health.
International research recently reported similar findings. Analysis of 16 studies with more than one million patients, more than 500,000 of whom were men, showed that women were 8% less likely to be correctly identified as having a stroke.
