Racial/Ethnic Disparities in Acute Ischemic Stroke Treatment Within a Telestroke Network

Abstract

Background: The growth of telestroke services expanded the reach of acute stroke treatment. However, ethnic disparities in receiving such treatment have not been fully assessed. Materials and Methods: We reviewed prospectively maintained data on patients evaluated through the Medical University of South Carolina telestroke program between January 2016 and November 2018. Outcomes included odds of receiving intravenous recombinant tissue plasminogen activator (tPA), receiving mechanical thrombectomy (MT), and achieving door-to-needle (DTN) time £60 and £45 min among patients receiving tPA. We used logistic regression to analyze the contribution of race/ ethnicity. Results: We included 2,977 patients, of whom 1,093 (36.7%) identified as nonwhite; of these, 1,048 patients (95.9%) identified as black or African American. Significantly more nonwhite patients were seen at a primary stroke center (PSC) (68.4% vs. 52.3% in whites, p < 0.001). However, white patients had significantly higher odds of receiving tPA (odds ratio [OR] 1.47, confidence interval [95% CI] 1.17-1.84). There was no significant difference in receiving MT between races. Among patients receiving tPA, whites had higher odds of DTN £45 min (OR 1.76, 1.20-2.57) and £60 min (OR 1.87, 95% CI 1.31-2.66). Conclusions: White patients had better odds achieving DTN £45 min and DTN £60 min if receiving tPA within a telestroke setting, as well as higher odds of receiving tPA, even after adjustment for comorbidities. This was noted despite white patients having less access to PSCs. However, larger scale studies are needed to further study the impact of ethnic disparities.

Blacks Are Less Likely to Present With Strokes During the COVID-19 Pandemic

“…However, our study is unique because it presents patient-level data in an area of high stroke rate and significant racial disparity. 12 , 13 Interestingly, unlike previous studies, our study shows higher percentage of patients received tPA, without delay in treatment, and that similar percentages of patients received mechanical thrombectomy. One possible explanation to the higher rate of thrombolysis is that, while not statistically significant, there was a trend for shorter symptom-onset to hospital arrival time during COVID-19 pandemic by about 15 minutes which could be clinically significant.…”

Alarming downtrend in mechanical thrombectomy rates in African American patients during the COVID-19 pandemic-Insights from STAR

“…8 The reduction in the number of AA patients receiving MT during the COVID-19 pandemic threatens to widen the gap in racial disparities given that most patients with emergent LVO would suffer from significant long-term disability if they do not receive treatment. [9][10][11] A recent study evaluating racial disparities among patients evaluated over a large telestroke network reported a significant drop among AA patients with acute ischemic stroke. 6 The overall drop in the number of AA patients presenting with acute stroke is a likely reason that there is a drop in the number of AA patients receiving MT.…”

Ambulatory care for epilepsy via telemedicine during the COVID-19 pandemic

“…The participation in the telephone survey on satisfaction was voluntary, which may introduce a selection bias; and responses from the patients who chose to participate in the study may not be representative of the entire clinic population. Furthermore, we did not study the contributions of racial disparities and disabilities on our patient cohort that have been previously reported to limit access to telemedicine [17] , [43] , [44] , [45] , [46] . A geodetic distance rather than driving distance was used in calculation of cost savings that can lead to underestimation of the actual magnitude of savings.…”