Asian-American more likely to have severe strokes, finds new study
The retrospective analysis published in the journal JAMA Neurology, further shows that Asian-American stroke patients were less likely to receive intravenous tissue plasminogen activator (IV tPA), and had worse functional outcomes than white patients. They also had more hemorrhagic complications after receiving tPA.
Overall stroke incidence and mortality in the U.S. is improving, but, little is known about the characteristics and clinical outcomes of acute ischemic stroke in Asian American individuals. Sarah Song, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, and colleagues conducted the study to compare the characteristics, care, and outcomes of Asian American and white patients with acute ischemic stroke.
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The research team studied 64,337 Asian-American patients and 1,707,962 white patients admitted for acute ischemic stroke to hospitals participating in the Get With The Guidelines–Stroke (GWTG-Stroke) program from 2004 to 2016. The GWTG-Stroke program was originally designed to facilitate quality improvement activities at individual stroke centers. After adjusting for patient and hospital variables, Asian Americans had:
- Fewer IV tPA administrations, but more symptomatic hemorrhage after tPA, and overall post-tPA complications.
- Higher in-hospital mortality, longer length of stay, and less independent ambulation at discharge.
- Greater stroke severity than white patients: NIH Stroke Scale (NIHSS) score ≥16.
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Hospitals volunteer to be in the GWTG-Stroke program, and quality of stroke care may be higher than in nonparticipating hospitals, Song and colleagues noted. And at baseline, the Asian-American and white cohorts in this study had differences: the white group was older and was more likely to have specific vascular risk factors like atrial fibrillation and coronary artery disease, while the Asian-American group was more likely to have diabetes.
While Asian-American ethnicity in this study encompassed individuals from multiple heritages -- Asian, Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and other groups -- information about subgroups was not available. Other limitations of the study included potential residual confounding, which may account for some of the findings. In addition, small differences became statistically significant in this analysis because of the large sample size, possibly inflating the importance of differences between Asian-American and white patients, wrote the authors.
"These findings warrant additional research toward improving clinical outcomes for Asian American patients with acute ischemic stroke," concluded the authors.
For further reference log on to 10.1001/jamaneurol.2018.4410