Department of Neurology, University of Miami Miller School of Medicine, Miami, FL USA.
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL USA.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105586. doi: 10.1016/j.jstrokecerebrovasdis.2020.105586. Epub 2021 Jan 5.
How race/ethnic disparities in acute stroke care contribute to disparities in outcomes is not well-understood. We examined the relationship between acute stroke care measures with mortality within the first year and 30-day hospital readmission by race/ethnicity.
The study included fee-for-service Medicare beneficiaries age ≥65 with ischemic stroke in 2010-2013 treated at 66 hospitals in the Florida Stroke Registry. Stroke care metrics included intravenous Alteplase treatment, in-hospital antithrombotic therapy, DVT prophylaxis, discharge antithrombotic therapy, anticoagulation therapy, statin use, and smoking cessation counseling. We used mixed logistic models to assess the associations between stroke care and mortality (in-hospital, 30-day, 6-month, 1-year post-stroke) and hospital readmission by race/ethnicity, adjusting for demographics, stroke severity, and vascular risk factors.
Among 14,100 ischemic stroke patients in the full study population (73% white, 11% Black, 15% Hispanic), mortality was 3% in-hospital, 12% at 30d, 21% at 6m, 26% at 1y, and 15% had a hospital readmission within 30 days. Patients who received antithrombotics early and at discharge had lower mortality at all time points, and the protective association for early antithrombotic use was strongest among whites. Eligible patients who received statin therapy at discharge had decreased 6m and 1y mortality, but specifically among minority groups. Statin therapy was associated with lower 30-day hospital readmission.
Acute stroke care measures, particularly antithrombotic use and statin therapy, were associated with reduced odds of long-term mortality. The benefits of these acute care measures were less likely among Hispanic patients. Results underscore the importance of optimizing acute stroke care for all patients.
种族/民族差异在急性脑卒中护理中的作用如何导致结局差异尚不清楚。我们研究了急性脑卒中护理措施与种族/民族之间的死亡率与 30 天内再入院之间的关系。
该研究纳入了 2010-2013 年佛罗里达州脑卒中登记处 66 家医院治疗的年龄≥65 岁的接受医保付费服务的缺血性脑卒中患者。脑卒中护理指标包括静脉内使用阿替普酶、住院期抗血栓治疗、深静脉血栓形成预防、出院期抗血栓治疗、抗凝治疗、他汀类药物使用和戒烟咨询。我们使用混合逻辑回归模型来评估脑卒中护理与死亡率（住院期间、30 天、6 个月、1 年脑卒中后）以及按种族/民族划分的医院再入院之间的关系，同时调整了人口统计学、脑卒中严重程度和血管危险因素。
在全人群中（73%为白人，11%为黑人，15%为西班牙裔），14100 例缺血性脑卒中患者中，住院期间死亡率为 3%，30 天死亡率为 12%，6 个月死亡率为 21%，1 年死亡率为 26%，30 天内再入院率为 15%。早期和出院时接受抗血栓治疗的患者在所有时间点的死亡率均较低，而早期使用抗血栓治疗的保护作用在白种人中最强。在出院时接受他汀类药物治疗的合格患者，6 个月和 1 年的死亡率降低，但在少数民族中更为明显。他汀类药物治疗与 30 天内的医院再入院率降低相关。
急性脑卒中护理措施，特别是抗血栓治疗和他汀类药物治疗，与降低长期死亡率的几率相关。这些急性护理措施对西班牙裔患者的益处较小。结果强调了为所有患者优化急性脑卒中护理的重要性。
