Sex Differences in the Management of Suspected Stroke in a Telestroke Network

Abstract

BACKGROUND The evolution of ischemic stroke is different according to sex and is one of the main causes of death in women. In the literature, it is not clear if this is due to biological differences or to disparities in medical care. Previous studies have shown that women are less likely to receive acute treatment, and stroke center type is an important predictor of door-to-needle times. We investigated whether women are attended in a similar way to men in the telestroke network with specialized stroke physicians. METHODS A prospective registry of ischemic strokes recorded in the centralized Andalusian telestroke network (CATI) was analyzed, focusing on sex differences. Demographic data, clinical characteristics (risk factors), neuroimaging data, treatment intervals, and clinical results (the modified Rankin Scale [mRS] score) were collected. Functional outcomes were evaluated using the mRS at 90 days. RESULTS A total of 3009 suspected stroke patients were attended to in the telestroke network in the last three years, of which 42.74% were women. A total of 69.54% of the men and 63.85% of the women were diagnosed with ischemic stroke (p=0.002). Women were older (p>0.001) and less independent upon arrival (p=0.006) than men. There was no difference in the treatment received or in the treatment intervals between the groups. Importantly, there was no difference in mRS scores at 3 months between sexes. However, at follow-up, women had fewer imaging tests (p = 0.018) and fewer outpatient visits (p<0.001) than men. CONCLUSIONS No significant difference between men and women has been found in the acute treatment of stroke in a large telestroke network. However, the same is not true for the follow-up and management of patients after the acute phase. This fact supports that strict adherence to protocols, training, and specialization of care and providing equal attention prevents sex differences in stroke treatment and functional outcomes.