More research needed to explore potential racial, gender and socioeconomic differences in telestroke treatment

Research presented today at the Society of NeuroInterventional Surgery’s (SNIS) 22nd Annual Meeting included three studies that explored the differences in treatment and recovery options for patients across racial, gender and socioeconomic lines in a large telestroke network in Pennsylvania and a university medical center in Rhode Island.

Telestroke treatment aims to improve care for people with stroke symptoms who live far from comprehensive stroke centers—hospitals that offer a full spectrum of neuroendovascular care, with access to thrombectomy always available. This minimally invasive procedure uses a catheter to reopen blocked brain arteries in an ischemic large vessel occlusion, the most common type of stroke.

Access to more specialized care such as this can improve a person’s chance of recovery after stroke, and telestroke programs help expand neurointerventionalists’ reach by allowing patients in rural areas to receive a virtual diagnosis and treatment recommendation at a hospital closer to home. This kind of care may help address geographic and racial disparities in stroke treatment by bringing services closer to people in historically underserved communities.

In two of the studies discussed today, 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, “Gender Differences in Acute Ischemic Stroke Outcomes within a Large Tele-stroke Network: A Retrospective Cohort Study,” researchers reviewed medical records of 7,947 patients with suspected ischemic stroke in a large telestroke network.

Although men and women in the study were equally likely to receive thrombectomy, only 13% of women received tissue plasminogen activator (tPA), an IV medication that breaks up the blood clots that cause stroke, while 15% of men did. Both men and women spent similar amounts of time in the hospital for treatment and received similar National Institutes of Health Stroke Scale scores at discharge.

In the second study, “Ethnic Disparities in Stroke Outcomes Mitigated by the Efficiency of a Large Tele-Stroke Network” the research team reviewed records from 2,952 white patients and 1,122 Black patients with suspected ischemic 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, emphasizing 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.

In the third study, “Effects of Neighborhood Disadvantage on Stroke Network Performance and Neurological Outcomes after Mechanical Thrombectomy,” researchers at Brown University reviewed records for patients at a large hospital who had received thrombectomies to treat stroke and calculated 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 center for thrombectomy, and the second half were just sent to the nearest hospital and later transferred to a comprehensive stroke center for the procedure.

The team categorized patients’ socioeconomic status using the Area Deprivation Index tool, which calculates how under-resourced or well-resourced each neighborhood is, finding that patients of all socioeconomic levels who were able to receive field triage and immediately be routed to the correct hospital had better outcomes after thrombectomy than patients who were later transferred to a comprehensive stroke center. However, for the group of patients who had to be transferred, the team found that patients from more disadvantaged neighborhoods had a longer wait for thrombectomy and worse health after stroke.

According to Basel Musmar, MD, the primary author of the first two studies and a postdoctoral research fellow at Thomas Jefferson University Hospital in Philadelphia, “It’s very encouraging to see that longstanding racial and gender disparities can be potentially mitigated using telestroke treatment.

“However, the reduced use of stroke treatment medication for female patients and the differences in care after hospital discharge between Black and white patients shows 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.”

“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, MD, MS, a neurosurgery resident at Brown University and the 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.”

Provided by
Society of NeuroInterventional Surgery

Research presented today at the Society of NeuroInterventional Surgery’s (SNIS) 22nd Annual Meeting included three studies that explored the differences in treatment and recovery options for patients across racial, gender and socioeconomic lines in a large telestroke network in Pennsylvania and a university medical center in Rhode Island.

Telestroke treatment aims to improve care for people with stroke symptoms who live far from comprehensive stroke centers—hospitals that offer a full spectrum of neuroendovascular care, with access to thrombectomy always available. This minimally invasive procedure uses a catheter to reopen blocked brain arteries in an ischemic large vessel occlusion, the most common type of stroke.

Access to more specialized care such as this can improve a person’s chance of recovery after stroke, and telestroke programs help expand neurointerventionalists’ reach by allowing patients in rural areas to receive a virtual diagnosis and treatment recommendation at a hospital closer to home. This kind of care may help address geographic and racial disparities in stroke treatment by bringing services closer to people in historically underserved communities.

In two of the studies discussed today, 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, “Gender Differences in Acute Ischemic Stroke Outcomes within a Large Tele-stroke Network: A Retrospective Cohort Study,” researchers reviewed medical records of 7,947 patients with suspected ischemic stroke in a large telestroke network.

Although men and women in the study were equally likely to receive thrombectomy, only 13% of women received tissue plasminogen activator (tPA), an IV medication that breaks up the blood clots that cause stroke, while 15% of men did. Both men and women spent similar amounts of time in the hospital for treatment and received similar National Institutes of Health Stroke Scale scores at discharge.

In the second study, “Ethnic Disparities in Stroke Outcomes Mitigated by the Efficiency of a Large Tele-Stroke Network” the research team reviewed records from 2,952 white patients and 1,122 Black patients with suspected ischemic 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, emphasizing 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.

In the third study, “Effects of Neighborhood Disadvantage on Stroke Network Performance and Neurological Outcomes after Mechanical Thrombectomy,” researchers at Brown University reviewed records for patients at a large hospital who had received thrombectomies to treat stroke and calculated 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 center for thrombectomy, and the second half were just sent to the nearest hospital and later transferred to a comprehensive stroke center for the procedure.

The team categorized patients’ socioeconomic status using the Area Deprivation Index tool, which calculates how under-resourced or well-resourced each neighborhood is, finding that patients of all socioeconomic levels who were able to receive field triage and immediately be routed to the correct hospital had better outcomes after thrombectomy than patients who were later transferred to a comprehensive stroke center. However, for the group of patients who had to be transferred, the team found that patients from more disadvantaged neighborhoods had a longer wait for thrombectomy and worse health after stroke.

According to Basel Musmar, MD, the primary author of the first two studies and a postdoctoral research fellow at Thomas Jefferson University Hospital in Philadelphia, “It’s very encouraging to see that longstanding racial and gender disparities can be potentially mitigated using telestroke treatment.

“However, the reduced use of stroke treatment medication for female patients and the differences in care after hospital discharge between Black and white patients shows 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.”

“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, MD, MS, a neurosurgery resident at Brown University and the 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.”

Provided by
Society of NeuroInterventional Surgery