Research presented recently at the Society of NeuroInterventional Surgery (SNIS) annual meeting (14–18 July, Nashville, USA)—across three studies—has explored differences in treatment and recovery options for patients in different racial, gender and socioeconomic groups within a large telestroke network and a university medical centre in the USA.
In two of the studies discussed, researchers reviewed thousands of medical records to see if patients’ treatment options and post-stroke health varied by race and gender.
In the first study, titled ‘Gender differences in acute ischaemic stroke outcomes within a large telestroke network: a retrospective cohort study’, researchers reviewed medical records for 7,947 patients with suspected ischaemic stroke in a large telestroke network. Although men and women in the study were equally likely to receive mechanical thrombectomy treatment, only 13% of women received tissue plasminogen activator (tPA) therapy compared to 15% of men. Both men and women spent similar amounts of time in the hospital for treatment and were found to have comparable National Institutes of Health stroke scale (NIHSS) scores at discharge.
In the second study, titled ‘Ethnic disparities in stroke outcomes mitigated by the efficiency of a large telestroke network’, the research team reviewed records from 2,952 white patients and 1,122 Black patients with suspected ischaemic stroke who received telestroke care. The study found that telestroke networks can help reduce racial disparities in acute stroke care, particularly in the administration of tPA and mechanical thrombectomy. Although immediate care was equitable across racial groups, post-stroke rehabilitation outcomes still differed, which the researchers feel emphasises the need for further research into long-term recovery and rehabilitation disparities. Addressing socioeconomic barriers and improving access to post-stroke care “will be crucial for achieving truly equitable stroke care”, they further state.
“It’s very encouraging to see that longstanding racial and gender disparities can be potentially mitigated using telestroke treatment,” said Basel Musmar (Thomas Jefferson University Hospital, Philadelphia, USA), primary author of these first two studies. “However, the reduced use of stroke treatment medication for female patients and the differences in care after hospital discharge between Black and white patients show that we need to further investigate these issues to ensure that gender and racial factors aren’t keeping people from experiencing optimal outcomes for stroke treatment.”
The third and final study, titled ‘Effects of neighbourhood disadvantage on stroke network performance and neurological outcomes after mechanical thrombectomy’, saw researchers at Brown University (Providence, USA) review records for patients at a large hospital who had received thrombectomies to treat stroke and calculate how their socioeconomic status might have affected their time to stroke treatment. Half of the patients studied had received field triage—meaning that emergency medical services were able to assess them on the scene and immediately route them to a comprehensive stroke centre (CSC) for thrombectomy—while the second half were sent to the nearest hospital and later transferred to a CSC for the procedure.
The team categorised patients’ socioeconomic statuses using the Area Deprivation Index tool, which calculates how under-resourced or well-resourced each neighbourhood is, finding that patients of all socioeconomic levels who were able to receive field triage and be routed immediately to the correct hospital had better outcomes after thrombectomy versus patients who were later transferred to a CSC. However, for the group of patients who had to be transferred, the team found that patients from more disadvantaged neighbourhoods experienced a longer wait for thrombectomy and worse health after stroke.
“We were excited to see how impactful field triage can be in potentially reducing disparities in post-stroke health for people across the socioeconomic spectrum,” said Joshua Feler (Brown University, Providence, USA), primary author of the third study. “Finding the right uses for this important tool can hopefully cut down the time between a stroke and the treatment that gets people back to their lives.”
