A late-breaking science presentation at the International Stroke Conference (ISC) 2021 (17–19 March, online) reports that while the use of mechanical clot removal or endovascular thrombectomy (EVT) has increased, racial differences in treatment persist.
This study compared the use of EVT and post-stroke recovery among patients of different races/ethnicities before and after 2015, when EVT was confirmed to be an effective treatment for ischaemic stroke. Between April 2012 and June 2019, investigators also reviewed data in the American Heart Association’s Get With The Guidelines–Stroke programme, which includes a large, database of information about stroke treatment at hospitals across the US Since 2003, over 2,000 hospitals have entered more than five million patient records into the programme’s database.
- Overall, 14% of 302,965 potentially eligible patients received EVT and, in all groups, EVT increased over the course of the study.
- However, Black patients were 32% less likely to receive EVT before 2015 and still 17% less likely to receive it after 2015 when compared to non-Hispanic white patients.
- Differences also emerged related to stroke recovery. In terms of short-term outcomes, patients from under-represented racial and ethnic groups fared better than non-Hispanic white patients. In addition, Black, Hispanic and Asian patients were more likely to return home and less likely to die while hospitalised or to be discharged to hospice care.
- Three months later, however, Black patients were 16% less likely and Asian patients were 30% less likely to be able to function independently, compared to non-Hispanic white patients.
“It is reassuring that the treatment gap for Black patients has narrowed since 2015, yet it remains significant and is concerning. The most surprising finding was the discrepancy between short- and long-term outcomes in non-Hispanic white patients versus the patients in other race and ethnicity groups,” said study lead author Faheem G Sheriff, assistant professor of neurology at Texas Tech University Health Science Center of El Paso, USA “There is a lot of work that remains in terms of figuring out the root causes for these differences and how best to improve equitable access and care for all patients.”
Sheriff continued, “Once these root causes are identified, we can focus on formulating an action plan to reduce these differences, for both access to EVT and recovery afterwards, particularly post-discharge care.”