DOI: 10.1161/circ.148.suppl_1.14671 ISSN: 0009-7322

Abstract 14671: Investigating Health Disparities in Arrival From Last Known Well Times in Queens, NY

Stanley Pierre, Anna Huang, Shaun-marie Wilson, Vanessa Jules, Holson Holson, Denise Chuang, Debashree Sengupta, Jason Punsalan, Suja Mohan, Susan Thomas, Gilbert Merisier
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Stroke is a leading cause of death in the US and the third leading cause of disability worldwide, so timely access to care must be considered as it is a salient predictor of prognosis and outcomes. 1,2 Specifically, because the recommended treatment window for IV tPA (alteplase) is within 4.5hr of last known well (LKW), it is imperative for patients to present to the facility within 3.5hr from symptom onset to receive treatment. 3 There are known health disparities in stroke treatment/outcomes 4 , and this study seeks to explore the population of patients that disproportionately have unknown or LKW >4.5hr to arrival, and the impacts of such.

Methods: Stroke patients entered into the Get With The Guidelines™-Stroke excluding patients whose symptoms began after hospital arrival and were discharged from October 2021 to December 2022 from NYC Health + Hospitals/Queens were included. Arrival from LKW time was categorized into ≤0-4.5hr and >4.5hr. Covariates collected and included are age, Hispanic ethnicity, sex, race, final clinical diagnosis of stroke, and history of previous stroke. Logistic regression models were used to analyze data and results are presented as adjusted odds ratios at 0.05 significance.

Results: A total of 342 patients were included in this study with 211 patients arriving after 4.5hr. The median time to arrival from LKW was 829min. Notably, patients identifying as Asian were more likely to arrive within 4.5hr of LKW (3.21 adjusted OR, 95% CI 1.30-7.91, p = 0.01) compared to their Black counterparts. White patients were also more likely to arrive within the 4.5hr treatment window compared to Black patients (11.69 adjusted OR, 95% CI 3.39-40.36, p = 0.0001). Increase in age was associated with decrease in timely arrival from LKW (0.98 adjusted OR, 95% CI 0.96-0.99, p = 0.04). Clinically, those that were diagnosed with ischemic stroke were more likely to arrive within 4.5hr of LKW (2.55 adjusted OR, 95% CI 1.37-4.77, p = 0.003) as well as those with a history of previous stroke (2.74 adjusted OR, 95% CI 1.39-5.40, p = 0.004).

Conclusion: There are health disparities in stroke treatment because of prolonged patient arrival from or unknown LKW, and these findings will help inform further practices in community education and outreach.

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