Abstract WP278: Demographic Disparities in Extended Use of Tissue Plasminogen Activase in Acute Stroke Patients Treated via Telestroke


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Abstract

Introduction: Disparities have been demonstrated in acute ischemic stroke (AIS) treatment between age, gender, and racial/ethnic groups. Telestroke (TS) has been noted to decrease disparities in AIS care. As AIS management via TS increases and the inclusion criteria for tPA expands, it is crucial to evaluate differences among patients of various age, gender, and race/ethnicity with extended use of tPA (EU-tPA). EU-tPA was defined as patients with relative contraindications as per 2016 AHA/ASA scientific statement, and who have consented to receive EU-tPA.Hypothesis: We hypothesized that EU-tPA is administered at similar frequencies among patients of different age, gender, and racial/ethnic groups via TS.Methods: From 9/2015-3/2016, we identified 136 suspected AIS patients with reported relative contraindications to tPA in our TS registry who were evaluated by video consultation at one of 17 spoke hospitals. We compared the likelihood of receiving EU-tPA among patients of different age, gender, and racial/ethnic groups.Results: Of 136 suspected AIS patients with reported contraindications to tPA in our TS registry, 35 (25.7%) received EU-tPA. Demographic characteristics are presented in Table 1. There was no significant difference between gender and race/ethnicity in receiving EU-tPA. Patients who were older were less likely to receive EU-tPA and the difference persisted in the multivariate analysis (p=0.026). Similarly, patients with mild or rapidly improving symptoms were less likely to receive EU-tPA (p=0.001).Conclusion: Our study suggests that older patients receive EU-tPA less frequently. Although there was no significant difference between gender and racial/ethnic groups, there was a trend that Hispanics might receive EU-tPA less frequently than non-Hispanic whites. Additional prospective study is needed to evaluate reasons why older patients are less likely to receive EU-tPA.

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