Thursday, August 18, 2016

Minorities may not get best care after a stroke

Nonwhite patients were significantly less likely to get clot-busting therapy, for example, or to undergo a procedure to reopen a clogged artery in the neck that carries blood to the brain.

“Desirable” curative and preventive measures, “with excellent evidence for good outcome,” were underutilized in minority patients, said lead author Dr. Roland Faigle of Johns Hopkins University School of Medicine in Baltimore.

And “procedures meant for ‘damage control’ and based on (in some instances) shaky evidence” were overused in minorities, Faigle told Reuters Health by email.

To assess the extent of racial disparities in care, Faigle and colleagues looked at data from a nationwide sample of hospitalized stroke patients from 2007 to 2011.

They took into account a variety of factors that can influence stroke care in the hospital, including patient age, gender, insurance status, and other medical conditions that might make treatment more complicated, like diabetes or high blood pressure.

They also adjusted for hospital characteristics like the annual volume of stroke cases, total number of beds and whether it was a teaching hospital.

They found that nonwhite patients were 20 percent less likely to get a clot-busting therapy known as intravenous thrombolysis. They also had 43 percent lower odds of getting a procedure to reopen the carotid artery to prevent further stroke.
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The researchers also looked at four procedures that Faigle says aren’t backed by evidence of effectiveness in stroke patients: feeding tubes in the stomach, incisions in the wind pipe to aid breathing, mechanical ventilation for breathing assistance, and surgery to relieve swelling in the brain.

Minorities were 56 percent more likely to have feeding tubes than white patients, researchers report in JAMA Neurology.

Nonwhite patients were also 44 percent more likely to get incisions in the wind pipe to aide breathing and 36 percent more likely to receive surgery to relieve swelling in the brain.

One limitation of the study is that researchers lacked data on some patient characteristics that could influence what care they received such as stroke severity, stroke location and how much time passed between when symptoms started and patients arrived at the hospital, the authors note.

“We know there are significant differences in these clinical aspects with minorities typically having the more severe strokes with delays in time to care,” said Dr. Daniel Lackland, a neurology researcher at the Medical University of South Carolina in Charleston.

But the findings still point to a need for improvement.

“These results do suggest that all stroke cases do not have the same stroke care, and should stimulate implementation studies to increase access and utilization,” Lackland, who wasn’t involved in the study, said by email.

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