Objectives

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.

Materials and methods

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.

Results

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.

Conclusions

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.

中文翻译：

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坚持急性护理措施会影响缺血性中风患者的死亡率：佛罗里达中风登记处

目标

急性中风护理中的种族/民族差异如何导致结果差异尚不清楚。我们检查了急性卒中护理措施与第一年内死亡率和按种族/民族划分的 30 天再入院率之间的关系。

材料和方法

该研究包括 2010 年至 2013 年在佛罗里达州中风登记处的 66 家医院接受治疗的 65 岁以上的缺血性中风的按服务收费的医疗保险受益人。卒中护理指标包括静脉阿替普酶治疗、院内抗血栓治疗、DVT 预防、出院抗血栓治疗、抗凝治疗、他汀类药物使用和戒烟咨询。我们使用混合逻辑模型来评估卒中护理和死亡率（住院、卒中后 30 天、6 个月、1 年）和按种族/民族再入院之间的关联，并根据人口统计、卒中严重程度和血管危险因素。

结果

在整个研究人群中的 14,100 名缺血性卒中患者（73% 白人、11% 黑人、15% 西班牙裔）中，住院死亡率为 3%，30 天时为 12%，6m 时为 21%，1 年时为 26%，15% 30 天内再次入院。早期和出院时接受抗血栓药物治疗的患者在所有时间点的死亡率均较低，而对早期抗血栓药物使用的保护性关联在白人中最强。出院时接受他汀类药物治疗的合格患者降低了 6m 和 1y 死亡率，但特别是在少数群体中。他汀类药物治疗与较低的 30 天再入院率相关。

结论

急性卒中护理措施，特别是抗血栓药物的使用和他汀类药物治疗，与降低长期死亡率的几率有关。在西班牙裔患者中，这些紧急护理措施的益处不太可能。结果强调了为所有患者优化急性卒中护理的重要性。