Despite having worse stroke symptoms and living within comparable distances to comprehensive stroke centres (CSCs), women with large vessel occlusion (LVO) acute ischaemic stroke are less likely to be routed to these types of centres compared to men, according to a new study from UTHealth Houston (Houston, USA).
Led by corresponding author Sunil Sheth and senior author Youngran Kim (both UTHealth Houston, Houston, USA), the study was published recently in the Journal of the American Heart Association.
“Timely treatment of stroke is incredibly important; the faster a doctor is able to get the vessel open, the better the patient’s chance of having a good outcome,” said Sheth. “These routing systems in hospitals are designed to get patients to the best care as quickly as possible. We do not know exactly why women were less likely than men to be routed to comprehensive stroke centres, but we do know that gender is an implicit bias. Getting to the granular level of what went into a hospital’s routing decision will be very important for future studies.”
Researchers identified consecutive patients with LVO acute ischaemic stroke from a prospectively collected, multi-hospital registry for the Greater Houston area from January 2019 to June 2020. They compared prehospital routing of men and women to CSCs—which are capable of performing endovascular therapy (EVT) to remove the clot blocking an artery. Among 503 patients, 82% were routed to CSCs. Women made up 46% of the study participants.
Compared with men, women with LVO acute ischaemic stroke were older (73 versus 65 years of age), and presented with a greater average National Institutes of Health stroke scale (NIHSS) score (14 versus 12), meaning their symptoms were worse. After adjusting for differences in stroke type, age, travel distance, and other relevant factors, women were approximately 9% less likely than men to be routed to CSCs in the study.
“The greater NIHSS score in women may be partially attributed to their older age, as age itself is a known contributing factor to sex differences in stroke severity,” Kim said. “Moreover, elderly women are more likely to live alone and experience social isolation, which can result in delayed recognition of stroke symptoms and subsequent delays in seeking medical attention.”
Additionally, patients living within a 10-mile distance to the nearest CSC were 38% more likely to be routed to one.
Previous studies have shown that women with acute ischemic stroke are less likely than men to receive clot-busting intravenous tissue-plasminogen activator (tPA) treatment, and that women with stroke are 33% more likely to be misdiagnosed with non-stroke related issues, such as headache or dizziness, as per a UTHealth Houston press release.
“Older age at onset and severe stroke in women, compounded by a higher likelihood of age-related risk factors, can contribute to the higher rate of death from stroke and higher risk for disability after stroke in women,” Kim continued. “Therefore, appropriate triage and prehospital routing can be even more critical for women. Whether large vessel occlusions in women are less likely to be identified using current screening tools due to older age, premorbidity, or non-traditional symptoms, needs to be investigated.”