Temporal Trends in Quality of Acute Stroke and Secondary Stroke Prevention Care in Patients with Pre-stroke Disability in the Safe Implementation of Treatment in Stroke (SITS) Registry
Vanessa Ha1, Magnus Thoren2, Niaz Ahmed2, Charith Cooray2, Aravind Ganesh1
1University of Calgary, 2Karolinska Institutet
Objective:
To assess the quality of stroke care received by patients with pre-stroke disability (PSD) over time.
Background:
Patients with PSD have worse stroke outcomes than those without PSD. The extent to which the quality of stroke care differs between patients with and without PSD remains uncertain.
Design/Methods:
We included patients who were enrolled in the SITS-International Stroke Treatment Registry between 2003 and 2021 and received IV thrombolysis with or without endovascular therapy. Patients with PSD had a baseline modified Rankin Scale (mRS) score ≥2. We performed logistic regression for dichotomous outcomes and linear regression for continuous outcomes adjusted for age, sex, year of stroke, stroke severity, and comorbidities. Time-trends were analyzed for each study year.
Results:
The mean age of patients with PSD (n=21,414) was 76.88±11.8 and without PSD (n=140,410) was 68.7±13.2. Of patients with indications (e.g. arterial occlusion, severe cerebral edema, and symptomatic carotid stenosis, respectively), patients with PSD were less likely to receive thrombectomy (aOR=0.49[95% CI: 0.44, 0.56]), hemicraniectomy (aOR=0.42[95% CIs: 0.19,0.93]), and carotid vascularization (aOR=0.63[95% CIs: 0.47,0.83]). Although patients with PSD were more likely admitted to the stroke unit, they were less likely to receive antiplatelet and anticoagulation (aOR=0.61[95%CI: 0.58,0.64]), statin (aOR=0.70[95% CI: 0.67,0.73]), and antihyperglycemic agents (aOR=0.86[95%CI 0.79,0.94]) at discharge. Patients with PSD were more likely to have stroke recurrence at 3 months with no evidence of change in the relationship over time even with additional adjustment for both stroke prevention medications and acute stroke intervention (aOR=1.25[95%CI:1.05,1.49]).
Conclusions:
In this observational registry-based study, patients with PSD were not only less likely to be offered acute stroke interventions, as might be expected, but were notably less likely to receive secondary stroke prevention therapies. These disparities may explain the higher risk of stroke recurrence in people with PSD, albeit confounding from extraneous factors cannot be ruled out.