Abstract WP228: Clinical Characteristics of Hmong Patients Presenting with Acute Ischemic Stroke

Abstract

Introduction: Hmong people are originally from the mountainous areas of Southeastern China, Northern Vietnam, Laos, and Thailand. Large numbers have migrated to the USA. In response to a request from leaders of the Hmong community and given the lack of literature, this study was conducted to describe ischemic stroke in the Hmong patients at our comprehensive stroke center. Methods: Institutional GWTG database and charts for years 2010-2015 were retrospectively reviewed. Hmong patients were identified by their last names (18 clans) provided by the Hmong community leaders. Different demographic, social, and clinical aspects were reported and compared to white patients in a univariate analysis. Results: Forty-one Hmong and 1510 White were included in the analysis. Compared to Whites, Hmong patients were significantly younger (60±2.16 vs. 70±0.39 years # ), predominantly women (66% vs. 48%; p=0.03), less frequently covered by medical insurance (68% vs. 87% # ) and less frequently brought by ambulance (44% vs. 54% # ). Onset-to-door time, door-to-needle time, NIHSS at admission, and incidence of vascular risk factors was similar between the two groups; however, Hmong patients seemed to have poorly controlled risk factors with mean A1C 11±0.9% in diabetics (n=13) and mean LDL 116±6.4 mg/dL in hyperlipidemics (n=16). The most common stroke mechanisms were small vessel (31%) and intracranial atherosclerotic diseases (27%). Based on imaging in Hmong patients; 56% had intracranial arterial calcification, 53% had microaniopathic disease, 46% had intracranial stenosis, and 18% extracranial stenosis. On echocardiogram, 68% of Hmong had left ventricular hypertrophy, 54% had dilated left atrium, one patient had hypokinesis, and none had low ejection fraction. The length of stay and the rate of independent ambulation on discharge were not different between Hmong and Whites, however, a larger proportion of Hmong were discharged home (59% vs. 46%; p=0.05). # p≤0.0005 Conclusion: In this study population, Hmong patients suffered from poorly controlled risk factors, had high incidence of small vessel and intracranial atherosclerotic disease, low incidence of carotid disease and heart failure and utilized fewer resources than Whites.

Stroke Characteristics in a Cohort of Hmong American Patients

“…We previously performed a retrospective analysis of inpatients discharged with a stroke diagnosis and found that Hmong patients (n=62) were younger than White patients; had poorly controlled risk factors; had high rates of intracerebral hemorrhage (ICH), intracranial atherosclerosis, and small‐vessel disease; and had low rates of use of ambulances and rehabilitation services. 15 In the current study, we aim to better characterize stroke in Hmong patients using a larger sample size and more detailed analysis of the clinical and radiological characteristics.…”