HOSPITAL DISPARITIES IN REPERFUSION THERAPY FOR PATIENTS WITH ACUTE ISCHEMIC STROKE

Abstract

Background and Aims: Health care disparities are widespread, including in stroke care. Reperfusion therapy is a standard treatment for acute ischemic stroke, but there may be disparities in relation to its utilization across hospitals.

Methods: Data from 75,870 patients admitted to 247 acute stroke care hospitals covering the entire country of South Korea were obtained from the Acute Stroke Quality Assessment Program of 2013-2018 held by the Health Insurance Review and Assessment Service. The primary outcome measure was the hospital reperfusion therapy rate (RTR) defined as the proportion of intravenous tissue plasminogen activator (IVT) and/or endovascular thrombectomy (EVT) cases in patients potentially eligible for reperfusion therapy (onset-to-arrival time ⩽6 hours, initial NIHSS score ⩾4). Hospital RTRs, adjusted for age, sex, onset-to-arrival time, and initial stroke severity, were correlated with hospital characteristics.

Results: During the study period, 10,513 stroke patients potentially eligible for reperfusion therapy were admitted to 247 acute care hospitals. RTR in the study population was 52.9%. The average hospital RTR was 34.8% [median (IQR) 37.5% (9.8 – 56.2)]. Higher number of beds and average stroke admission per month were associated with higher hospital RTR. Multivariable analysis revealed the average stroke admission per month, presence of stroke unit, the average IVT per month, and the average EVT per month were the independent determinants for hospital RTR. Hospital RTR was inversely correlated with 1-year mortality irrespective of hospital stroke volume.

Conclusions: Hospital RTRs vary widely, and higher hospital stroke volumes are associated with higher hospital RTRs. Higher hospital RTRs are correlated with lower 1-year mortality.