Abstract 94: Blacks Arrive Later After Stroke Onset Than Whites in Chicago
Objective: To assess if ethnic disparities exist in the use of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) at primary stroke centers (PSCs) in Chicago, Illinois.
Background: Ethnic disparities in stroke care include observed differences in stroke incidence, severity, mortality, acute management, and rehabilitation. There are less data regarding race disparities in the use of emergency medical services (EMS) and delivery of tPA.
Methods: A retrospective analysis of the Get With The Guidelines (GWTG) Stroke registry was performed using a benchmark group of 11 PSCs that collected data on stroke admissions in 2012. We analyzed use of EMS, time from onset to arrival, tPA use, door to needle (DTN) time, and documented reasons for not administering tPA between blacks and white stroke patients.
Results: In 2012, there were 2,682 stroke patients admitted to Chicago PSCs. The mean age was 65.2 years with 54.3% women, 50.4% black, and 38.5% white. Among ED arriving ischemic stroke patients, 12% received tPA; however, it differed by race (whites: 21.6% vs. black: 8.3%; p<0.001). Use of EMS (whites: 55.8% vs. blacks: 51.6%, p=0.172) did not differ by race but pre-notification was less frequent for black patients arriving by EMS (59.5% vs. 78.5%, p<0.001). Time from onset to ED arrival was longer in blacks (median 152.5 minutes vs. 85 minutes in whites), even among those using EMS (blacks: median 100.5 minutes vs. whites: 66 minutes). Among thrombolysed patients, DTN times were similar (81 vs. 83 minutes) between groups. However, blacks who did not receive tPA but presented in the 4.5 hour window were less likely to have documented contraindications to thrombolysis (67.1% vs. 82.5%, p=0.008) and more likely to have in-hospital delays (33.3% vs. 17.4%, p=0.243) compared to whites.
Conclusions: At Chicago’s PSCs, blacks are much less likely than whites to receive tPA for stroke despite similar proportions accessing EMS. While some of this disparity may be accounted for stroke severity and type of stroke symptoms, delays in calling EMS and differences in pre-hospital notification and hospital evaluation are potential targets for public and professional education.
Author Disclosures: N. Aggarwal: None. K. O'Neill: None. H. Beckstrom: None. S. Song: None. S. Hoelzel: None. B. Joyce: None. H. Gavras: None. S. Martin: None. C. Richards: None. M. Masor: None. D. Jenkins-West: None. L. Owens: None. S. Prabhakaran: None.
- © 2014 by American Heart Association, Inc.