Abstract 89: Differences in Acute Stroke Care in Primary and Comprehensive Stroke Centers in Florida: An Analysis of the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study- the NINDS Stroke Prevention Intervention Research Program
Introduction: Primary stroke center (PSC) and comprehensive stroke center (CSC) designation in Florida aims to improve delivery of care and outcomes for stroke patients. In line with the goals of the NINDS funded Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study, we sought to compare ischemic stroke performance metrics by stroke center designation in participating Florida hospitals.
Methods: We analyzed 74,623 cases with acute ischemic stroke from 26 CSC and 40 PSC from January 2010-April 2016. We described patient demographics, comorbidities and Get With The Guidelines-Stroke performance metrics of defect free care (compliance with 7 pre-defined performance core measures), door to CT time (DTCT) ≤25 mins and door to needle time (DTN) ≤60 mins.
Results: Compared with PSC patients, CSC patients were younger (70 ± 15 vs. 71 ± 14 years, p<.0001), more likely male (51% vs. 50%, p=.0008), more likely Hispanic (17% vs. 10%, p<.0001) and Black (21% vs. 17%, p<.0001), had more severe strokes (NIHSS median 5 (IQR 2-12) vs. 4 (IQR 1-9); NIHSS ≥16, 12% vs. 9%, p <.0001), were more likely to have atrial fibrillation (19% vs. 17%, p<.0001), and were more likely to arrive by EMS (55% vs. 46%, p<.0001). CSC cases were more likely to have faster DTCT (44 vs. 48 mins, p=.0124; <25 mins 33% vs. 31%, p<.0001). More patients in CSC received thrombolysis (12% vs. 9%, p<.0001), with faster DTN (59 vs. 71 min, p <.0001; ≤60 minutes 53% vs. 37%, p <.0001). Patients in CSC had greater rates of defect free care (85% vs. 82.4%, p<.0001). Blacks had longer median DTCT than Whites and Hispanics in both CSC (56 mins Blacks vs. 41 mins Whites and Hispanics) and PSC (60 mins Blacks, 44 mins Whites, 57 mins Hispanics). Blacks in CSC had longer median DTN (63 mins) than Whites (60 mins) and Hispanics (53 mins). Hispanics had longer median DTN (73 mins) in PSC than Blacks (70 mins) and Whites (70 mins).
Conclusion: Patients treated in CSC, compared with those treated in PSC, received better defect-free care and had lower DTCT and DTN times. Race-ethnic disparities in performance metrics are still evident in both CSC and PSC. Identification of these disparities is important to design interventions to reduce disparities and improve stroke quality of care for all.
Author Disclosures: E.T. Marulanda-Londoño: None. M.A. Ciliberti-Vargas: None. K. Wang: None. N. Asdaghi: None. M. Ayodele: None. C. Dong: None. H. Gardener: None. C.M. Gutierrez: None. W.S. Burgin: Other Research Support; Modest; ATACH-II: A Phase III Randomized Multicenter Clinical Trial of Blood Pressure Reduction for Hypertension in Acute Intracerebral Hemorrhage., CLOTBUST-ER in Acute Ischemic Stroke. Protocol Number: CP-01. PI: William Scott Burgin MD. Cerevast Therapeutics, SOCRATES –Acute Stroke Or Transient IsChaemic Attack TReated with Aspirin or Ticagrelor and Patient Outcomes. D. Foster: None. J. Gonzalez Sanchez: None. N. Mueller-Kronast: Consultant/Advisory Board; Modest; Medtronic Neurovascular Consultant. U.L. Nobo: None. M. Robichaux: None. D.Z. Rose: None. C. Sand: Speakers’ Bureau; Modest; Boehringer Ingelheim Pharmaceuticals, Inc. (PRADAXA®, dabigatran etexilate), Chiesi-USA (prior Cornerstone Therapeutics) (CARDENE IV ®, Nicardipine). S.P. Waddy: Employment; Modest; NINDS Health Disparities Program Director Program Director. R.L. Sacco: Research Grant; Modest; Boehringer Ingelheim for RESPECT ESUS trial. T. Rundek: 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).
- © 2017 by American Heart Association, Inc.