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Published on: February 26, 2013
Disparities and Temporal Trends in Stroke Care Outcomes in Patients with Atrial Fibrillation: The FLiPER-AF Stroke
Chuanhui Dong1,2, Kefeng Wang1, Marco R Di Tullio3
1Department of Neurology, University of Miami Miller School of Medicine, Florida, USA.
Insights
Atrial Fibrillation (AF) increases stroke severity, leading to worse outcomes and longer hospital stays. Disparities in care exist based on sex and race-ethnicity, requiring further investigation.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial Fibrillation (AF) is a primary cause of ischemic stroke.
- Understanding AF's impact on stroke outcomes across diverse populations is crucial.
Purpose of the Study:
- To investigate sex and race-ethnic disparities in hospital stroke outcomes among patients with AF.
- Utilizing data from the FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study.
Main Methods:
- Analysis of 104,308 ischemic stroke cases from a state-wide stroke registry (2010-2016).
- Multivariable logistic regression to assess AF association with stroke outcomes.
- Evaluation of modification effects by sex and race-ethnicity, adjusting for confounders.
Main Results:
- AF cases (23%) showed worse disability, reduced home discharge, and longer hospital stays.
- Stronger AF association with reduced home discharge in women and White populations.
- Greater AF impact on prolonged hospital stay observed in Puerto Rican Hispanics.
Conclusions:
- AF is linked to adverse stroke outcomes, including disability and prolonged hospitalization.
- Significant sex and race-ethnic disparities exist in AF's impact on stroke care.
- Further research is needed to address and mitigate these disparities in care.
Background And Purpose:
Atrial Fibrillation (AF) is the most common cardiac cause of ischemic stroke. However, the relation between AF and stroke care outcomes in diverse populations is understudied. We aimed to evaluate sex and race-ethnic disparities associated with AF in hospital stroke outcomes utilizing data from the FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study.
Methods:
The study included 104,308 ischemic stroke cases with available information on AF status enrolled in a state-wide stroke registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the association between AF and stroke outcomes and the modification effects on the associations by sex and by race-ethnicity, adjusted for socio-demographic status, vascular risk factors and stroke severity.
Results:
AF was present in 23% of ischemic stroke cases. AF was associated with worse disability at discharge (OR=1.11, 95% CI, 1.04-1.18), less discharge to home (OR=0.89, 0.85-0.92), and longer length of hospital stay (LOS>6 days, OR=1.53, 1.46-1.60). Interaction analyses showed that the association between AF and less discharge to home was stronger in women than men (p for interaction <0.001), as well as in FL-whites than in FL-blacks, FL-Hispanics or PR-Hispanics (p for interaction=0.002). The association between AF and prolonged LOS was more prominent in PR-Hispanics than in FL-blacks, FL-Hispanics, or FL-whites (p for interaction <0.001). From 2010 to 2016, the effects of AF on hospital length of stay attenuated (p for interaction<0.001).
Conclusions:
AF was associated with poor disability at discharge, less discharge to home, and prolonged hospital length of stay for acute stroke care. The effect of AF on length of stay attenuated over time. Sex and race-ethnic disparities were observed in the effect of AF on being less discharge to home and prolonged hospital stay. Further research is needed to identify and modify the biologic and systems of care contributors to these disparities.
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