Thrombolytic Refusal Over Telestroke

Zha, Alicia; Rosero, Adriana; Malazarte, Rene; Bozorgui, Shima; Ankrom, Christy; Zhu, Liang; Joseph, Michele; Trevino, Alyssa; Cossey, Tiffany D; Savitz, Sean I; Wu, Tzu Ching; Jagolino‐Cole, Amanda

doi:10.1212/cpj.0000000000000975

Cited by 3 publications

(4 citation statements)

References 33 publications

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“…62 In this study, the most common reasons for refusal were rapidly improving and mild/nondisabling symptoms and concern for potential side effects. 62…”

Section: Strategies To Reduce Inequities In Acute Care Deliverymentioning

confidence: 65%

“…61 Within the Lone Star Stroke Consortium Telestroke Registry from September 2015 to December 2018, among 1242 patients eligible for thrombolytic treatment, ≈8% refused this treatment, this being more common in women, non-Hispanic Black patients, and patients with a history of stroke. 62 In this study, the most common reasons for refusal were rapidly improving and mild/nondisabling symptoms and concern for potential side effects. 62 Acute Care Delivery: Artificial Intelligence and Machine Learning in Clinical Decision-Making Health care systems are rapidly adopting artificial intelligence (AI) and machine learning in clinical diagnosis and decision-making in the neurological realm.…”

Section: Acute Care Delivery: Telehealthmentioning

confidence: 65%

“…62 In this study, the most common reasons for refusal were rapidly improving and mild/nondisabling symptoms and concern for potential side effects. 62 Acute Care Delivery: Artificial Intelligence and Machine Learning in Clinical Decision-Making Health care systems are rapidly adopting artificial intelligence (AI) and machine learning in clinical diagnosis and decision-making in the neurological realm. Such a system includes the perfusion software used by stroke neurologists to help identify candidates who would benefit from reperfusion therapy.…”

Section: Acute Care Delivery: Telehealthmentioning

confidence: 65%

Section: Strategies To Reduce Inequities In Acute Care Deliverymentioning

confidence: 65%

See 3 more Smart Citations

Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart Association

Towfighi¹,

Boden‐Albala²,

Cruz‐Flores³

et al. 2023

Stroke

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Stroke is a disease of disparities, with tremendous racial and ethnic inequities in incidence, prevalence, treatment, and outcomes. The accumulating literature on the relationship between stroke and social determinants of health (ie, the structural conditions of the places where people live, learn, work, and play) contributes to our understanding of stroke inequities. Several interventions have been tested concurrently to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control. It is regrettable that no common theoretical framework has been used to facilitate comparison of interventions. In this scientific statement, we summarize, across the stroke continuum of care, trials of interventions addressing racial and ethnic inequities in stroke care and outcomes. We reviewed the literature on interventions to address racial and ethnic inequities to identify gaps and areas for future research. Although numerous trials tested interventions aimed at reducing inequities in prehospital, acute care, transitions in care, and poststroke risk factor control, few addressed inequities in rehabilitation, recovery, and social reintegration. Most studies addressed proximate determinants (eg, medication adherence, health literacy, and health behaviors), but upstream determinants (eg, structural racism, housing, income, food security, access to care) were not addressed. A common theoretical model of social determinants can help researchers understand the heterogeneity of social determinants, inform future directions in stroke inequities research, support research in understudied areas within the continuum of care, catalyze implementation of successful interventions in additional settings, allow for comparison across studies, and provide insight into whether addressing upstream or downstream social determinants has the strongest effect on reducing inequities in stroke care and outcomes.

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“…62 In this study, the most common reasons for refusal were rapidly improving and mild/nondisabling symptoms and concern for potential side effects. 62…”

Section: Strategies To Reduce Inequities In Acute Care Deliverymentioning

confidence: 65%

Section: Acute Care Delivery: Telehealthmentioning

confidence: 65%

Section: Acute Care Delivery: Telehealthmentioning

confidence: 65%

Section: Strategies To Reduce Inequities In Acute Care Deliverymentioning

confidence: 65%

See 2 more Smart Citations

Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart Association

Towfighi¹,

Boden‐Albala²,

Cruz‐Flores³

et al. 2023

Stroke

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Reasons withholding intravenous thrombolysis for acute ischemic stroke in an Indonesian Tertiary Center

Situmeang

Pangestu

Stevano

et al. 2023

Egypt J Neurol Psychiatry Neurosurg

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Background Intravenous thrombolysis is the current therapy of choice in patients with acute ischemic stroke (AIS). While highly effective, the rate at which the procedure is employed is low. Studies evaluating the causes withholding thrombolytic treatment in developing nations remain scarce. We aim to determine the factors withholding thrombolytic treatment in AIS patients. Methods This is a retrospective study of AIS patients at Siloam Hospitals Lippo Village, Indonesia, in a 10-month period between April 2019 to February 2020. Patient data were collected from the medical records. Results One hundred and forty-five cases of AIS were found within a 10-month period (April 2019 to February 2020). Thrombolysis was performed in 6.90% of all patients with AIS (21.28% when adjusted for eligible patients with onset ≤ 4.5 h). Prehospital delay exceeding 4.5 h was the most common cause of withholding thrombolytic treatment (68.28% of patients present above 4.5 h or with unknown onset). Among patients presenting ≤ 4.5 h, causes withholding thrombolysis include clinical improvement (35.14%), mild non-disabling symptoms (32.43%), patient/family refusal (18.92%), extensive infarction (5.41%), seizures at onset (2.7%), as well as history of acute bleeding diathesis (2.7%) and gastrointestinal bleeding (2.7%). Conclusions Prehospital delay constitutes the primary obstacle toward receiving thrombolytic therapy for AIS, especially in developing countries. Among patients with onset below 4.5 h, other notable causes include clinical improvement, mild non-disabling symptoms, and patient/family refusal. Of note, the rate of patient/family refusal in our study was much higher compared to previous findings, which may reflect possible socio-economic, communication, or educational issues.

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Effects of Social Determinants of Health on Acute Stroke Care Among Patients With Acute Ischemic Stroke

Dhanasekara,

Kahathuduwa,

Quispe-Orozco

et al. 2024

Neurology

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Background and ObjectivesSocial determinants of health (SDOH) are important contributors to poor stroke-related outcomes. While some have suggested that this association is driven by the increased incidence of stroke observed with poor SDOH, others have raised concerns regarding disparities in acute stroke care. This study aimed to determine the association between SDOH and the administration of thrombolytic therapy and mechanical thrombectomy among patients with acute ischemic stroke.MethodsA retrospective cohort analysis was conducted using Texas Emergency Department Public Use Data (2016–2019), including adult patients diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (Social Vulnerability Index [SVI]) were computed using mixed-effects Poisson regression models accounting for the nested nature of patients in hospitals and neighborhoods. The Charlson comorbidity score was considered as a covariate.ResultsOf the 139,852 patients with ischemic stroke (female, 51.7%; White, 67.2%; Black, 16.6%; Hispanic, 25.1%), 16,831 (12.3%) received thrombolytic therapy and 5,951 (4.3%) received mechanical thrombectomy. Age older than 65 years (RR 0.578 [0.537–0.621]) vs 18–45 years, Black (RR 0.801 [0.761–0.844]) vs White, Hispanic (RR 0.936 [0.895–0.98]) vs non-Hispanic, Medicare/Medicaid/Veterans Affairs (VA) (RR 0.917 [0.882–0.954]) or uninsured (RR 0.883 [0.833–0.935]) vs private insurance, and rural (RR 0.782 [0.723–0.845]) vs urban dwelling were less likely to be associated with thrombolysis. Patients in the highest quintile based on the SVI were less likely to receive thrombolysis than those in the lowest quintile (RR 0.926 [0.867–0.989]). Patients were less likely to receive thrombectomy if they were 65 years and older (RR 0.787 [0.691–0.895]), belonged to the Black race (RR 0.745 [0.679–0.818]) or Hispanic ethnicity (RR 0.919 [0.851–0.992]), had Medicare/Medicaid/VA insurance (RR 0.909 [0.851–0.971]), or were from a rural area (RR 0.909 [0.851–0.971]). Similarly, SVI decreased the likelihood of undergoing mechanical thrombectomy (RR 0.842 [0.747–0.95]).DiscussionDespite many improvements in stroke management, SDOH continue to be a significant driver of treatment access for acute ischemic stroke. While our findings are limited to Texas, our results should raise awareness and promote more studies regarding the effects of these SDOH at the national and international levels.

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Thrombolytic Refusal Over Telestroke

Cited by 3 publications

References 33 publications

Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart Association

Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart Association

Reasons withholding intravenous thrombolysis for acute ischemic stroke in an Indonesian Tertiary Center

Effects of Social Determinants of Health on Acute Stroke Care Among Patients With Acute Ischemic Stroke

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