Abstract W P283: Race-Ethnic Stroke Disparities in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study - The NINDS Stroke Prevention Intervention Research Program
Background: Race-ethnic disparities in stroke care can contribute to inequality in stroke outcomes. We sought to determine the disparities in stroke performance metrics by race-ethnicity in a voluntary stroke registry of Florida and Puerto Rico Get With The Guidelines-Stroke (GWTG-S) data.
Methods: Sixty-three sites who had enrolled in the FL-PR Stroke Registry (54 FL; 9 PR) recorded 38,684 ischemic stroke cases from 2010 to 2013. Generalized linear regression models were used to evaluate race-ethnic differences in 7 pre-defined acute stroke performance measures and defect-free care (IV tPA treatment, in-hospital antithrombotic therapy, DVT prophylaxis, antithrombotic therapy at discharge, anticoagulation therapy, statin medication at discharge, and smoking cessation counseling), adjusting for age and region (FL vs. PR).
Results: Of acute ischemic stroke cases, 63% were non-Hispanic White (NHW), 18% NH-Black (NHB), and 17% Hispanic. The mean age was 71±14 years. NHW were older (73±14), followed by Hispanics (70±14), and NHB (63±14); p<0.0001. Defect-free care was better among NHB (78%) and NHW (76%) than in Hispanics (68%), p<0.0001. Defect-free care improved over time and the race-ethnic disparity decreased (2010: NHW 61%, NHB 64%, Hispanic 46%, p<0.0001; 2013: 91%, 91%, 86%, p=0.47 respectively). NHW were most likely to receive IV tPA treatment (arrived by 2 hours and treated by 3 hours; 88%) and early antithrombotic treatment (96%). Hispanics were least likely to receive DVT prophylaxis (76%), anticoagulation (92%), statins (89%), and smoking cessation counseling (93%).
Conclusions: Race-ethnic disparities in acute stroke care are evident yet decreasing, coinciding with improvements in quality of care over time in Florida and Puerto Rico hospitals participating in GWTG-S. Special stroke quality improvement programs to target areas where performance is less than expected and minimize race-ethnic disparities are necessary to improve stroke care for all Americans.
Author Disclosures: R.L. Sacco: Consultant/Advisory Board; Modest; Boehringer Ingelheim con. H. Gardener: None. K. Wang: None. C. Dong: None. M.A. Ciliberti-Vargas: None. J.G. Romano: Other Research Support; Significant; Research salary support to Department of Neurology at the University of Miami from Genentech (for role as PI of the Mild and Rapidly Improving Stroke Study (MaRISS). Consultant/Advisory Board; Modest; Genentech (for Steering Committee role of the Potential for rtPA to Improve Stroke with Mild Symptoms (PRISMS) Study), Vycor/NovaVision (for Scientific Advisory Board role). W.S. Burgin: Research Grant; Modest; Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-II: A Phase III Randomized Multicenter Clinical Trial of Blood Pressure Reduction for Hypertension in Acute Intracerebral Hemorrhage. Cl, A Phase 3, Randomized, Placebo-Controlled, Double-Blind Study of the Combined Lysis of Thrombus with Ultrasound and Systemic Tissue Plasminogen Activator (tPA) for Emergent Revascularization (CLOTBUST, A Randomised, Double-Blind, Multinational Study to Prevent Major Vascular Events with Ticagrelor Compared to Aspirin (ASA) in Patients with Acute Ischaemic Stroke or TIA [SOCRATES –Acute Stroke Or Tra. O. Carrasquillo: None. E.J. Garcia-Rivera: None. S. Koch: None. J.F. Meschia: None. J.A. Nelson: Consultant/Advisory Board; Modest; Consultant and Advisory Board Member Health & Safety Institute 1450 Westec Dr. Eugene, OR 97402. U. Nobo: None. M. Robichaux: Employment; Significant; VP, Quality and Systems Improvement, Greater Southeast Affiliate. D.Z. Rose: Speakers' Bureau; Modest; Boehringer Ingelheim Pharmaceuticals, Inc. (PRADAXA®, dabigatran etexilate), 2013-current, Chiesi-USA (prior Cornerstone Therapeutics) (CARDENE IV ®, Nicardipine), 2013-current. Other; Modest; 7% book royalties for “Laughing Your Way to Passing the Neurology Boards” (2nd edition), Sept., 2013; Medhumor Medical Publications, LLP, Stamford, CT.. F.L. Santiago: None. M.F. Waters: None. J.C. Zevallos: None. T. Rundek: None.
- © 2015 by American Heart Association, Inc.