Abstract TMP81: Regional, Race-Ethnic and Sex Disparities in Lifestyle Interventions: Data from the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study - the NINDS Stroke Prevention Intervention Research Program
Background: As key components of the AHA Life’s Simple 7 campaign, lifestyle modifications play an integral role in the prevention of vascular disease. Little is known about the prevalence of lifestyle modification counseling in patients with acute ischemic stroke (AIS). We sought to investigate disparities in the delivery of lifestyle interventions to AIS patients in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data.
Methods: GWTG-S collects data on the provision of several lifestyle interventions including counseling on exercise/weight loss, Therapeutic Lifestyle Changes (TLC) diet, diabetes (DM) education and antihypertensive (low sodium) diet. 80,598 AIS cases were prospectively included from 82 sites (69 FL; 13 PR) from 2010-2016. Multilevel logistic regression models adjusted for age, race, and aphasia were used to evaluate differences in the provision of lifestyle interventions as indicated for patients prior to hospital discharge.
Results: Among AIS cases, 51% were men, 62% non-Hispanic White (NHW), 18% NH-Black (NHB), 13% FL-Hispanic (FLH), and 6% PR-Hispanic (PRH). Mean age was 71±14 years. The highest mean BMI was in PRH (29±7 kg/m2), with the lowest in NHW (27±6 kg/m2) and FLH (28±6 kg/m2). Despite this, PRH were less likely to receive exercise/weight loss counseling compared to NHW (OR 0.43, 95% CI 0.20-0.90) and FLH (OR 0.46, 95% CI 0.22-0.97). PRH also had lower odds of receiving TLC diet counseling compared to NHW and FLH (OR 0.32, 95% CI 0.15-0.68). Though NHB presented with higher rates of DM compared to NHW (38% vs. 25%), they were less likely to receive DM education (OR 0.95, 95% CI 0.91-0.99). Women were less likely to receive TLC diet counseling (OR 0.94, 95% CI 0.90-0.98) and DM education (OR 0.94, CI 0.92-0.97) compared to men. Despite higher HTN frequency in women and NHB (67% and 69%), both were less likely to receive low sodium diet recommendations as compared to men (OR 0.94, 95% CI 0.92-0.97) and NHW (OR 0.95, 95% CI 0.91-0.99).
Conclusion: Overall, disparities were identified in the provision of several lifestyle interventions in AIS patients. These interventions can benefit all and providers should continue counseling patients regarding modifiable risk factors to prevent future stroke.
Author Disclosures: M.A. Ciliberti-Vargas: None. K. Wang: None. S. Oluwole: None. E. Marulanda-Londoño: None. M. Ayodele: None. C. Dong: None. C.M. Gutierrez: None. 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, Adnan I. Qureshi MD, Clinical Site PI: David Z. Rose MD. The National Institute of Neurological Disorders and Stroke (NINDS), 11/2011-current, 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. D. Foster: Employment; Significant; VP Quality and Systems Improvement, GSA AHA. E.J. Garcia-Rivera: None. J. Gonzalez- Sanchez: None. M. Robichaux: Consultant/Advisory Board; Modest; Consultant, FL-PR CReSD. S.P. Waddy: Employment; Significant; Program Director, National Institute of Neurological Disorders and Stroke, NIH. J.C. Zevallos: Consultant/Advisory Board; Modest; Consultant, FL-PR CReSD. 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). T. Rundek: None. R.L. Sacco: Research Grant; Modest; Boehringer Ingelheim for RESPECT ESUS trial. S. Koch: None.
- © 2017 by American Heart Association, Inc.