Abstract TP2: Disparities in Delivery of Endovascular Therapy: Who Gets it and Where? The Florida Puerto Rico Collaboration to Reduce Stroke Disparities Study
Background and Purpose: Endovascular thrombectomy improves functional outcome in select ischemic stroke patients. In the NINDS-funded CReSD Registry we sought to determine the clinical, hospital and regional characteristics associated with use of this therapy in patients presenting with acute ischemic stroke.
Methods: Ischemic stroke patients within 24 hours of onset were prospectively included from 82 sites in Florida and Puerto Rico from January 2010 to April 2016. Independent predictors of endovascular therapy were evaluated using multivariable logistic regression with generalized estimating equations.
Results: Among 58,204 patients with acute ischemic stroke (50% male, 65% white, 15% black, 20% Hispanic, mean age±SD 71±14 yrs), 2105 (3.6%) received endovascular thrombectomy (50.9% men, 62.3% white, 13.7% black, 24% Hispanic, mean age±SD 70±15yrs) with (35.2%) or without intravenous thrombolysis. Patients who received endovascular therapy had a significantly lower risk of vascular risk factors except for Afib (33.7% vs 19.0%), more severe strokes (median NIHSS 15 vs. 5) and were more likely to arrive quickly (126 min vs. 210 min), via EMS (70.4% vs. 59.6%) or as a transfer from another hospital (20.8% vs 5.8%,) during working hours (47.7% vs. 45.6%), to large hospitals (≥ 680 beds) (48.3% vs 28.8%), and treated in South Florida (47.3% vs. 35.9%) as compared to those not receiving this treatment. In multivariable analysis; age (OR 0.97, 95% CI 0.96- 0.98), Blacks (OR 0.68, 95% CI 0.56-2.28) vs. White, off-hour presentation (OR 0.76, 95% CI 0.66- 0.96), to regions other than South Florida (North OR 0.40, 95% CI 0.17-0.93, Panhandle OR 0.12, 95% CI 0.04-0.36) remained independently associated with lower use of endovascular therapy. In contrast, Hispanics (OR 1.28, 95% CI 1.03- 1.69) vs. White and presenting to large hospital (OR 4.92, 95% CI 1.05- to 22.6) were associated with higher use of endovascular treatment.
Conclusions: There are significant race, regional and hospital disparities in delivery of endovascular care. Efforts should me made to improve access to endovascular treatment in patients presenting across the region to all stroke centers.
Author Disclosures: N. Asdaghi: None. L. Granzoti Cintra: None. K. Wang: None. M.A. Ciliberti-Vargas: None. S. Koch: None. H. Gardener: None. C. Dong: None. E. Marulanda-Londono: None. 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. S.P. Waddy: Employment; Significant; Program Director, NINDS NIH. N. Mueller-Kronast: Consultant/Advisory Board; Modest; modest. Consultant/Advisory Board; Significant; Medtronic Neurovascular Consultant. M. Robichaux: None. D. Foster: Employment; Significant; American Heart Association. E.J. Garcia: None. T. Rundek: None. R.L. Sacco: Research Grant; Modest; Boehringer Ingelheim for RESPECT ESUS trial. 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.