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Rural Hospital Performance in Guideline-Recommended Ischemic Stroke Thrombolysis, Secondary Prevention, and Outcomes
Shumei Man1, David Bruckman2, Ken Uchino3
1Department of Neurology, Neurological Institute (S.M.), Cleveland Clinic, OH.
Stroke
|September 5, 2024
Summary
Rural hospitals show lower thrombolytic use for ischemic stroke and slower treatment times compared to urban centers. However, rural stroke centers provide comparable secondary prevention to urban centers, highlighting opportunities for improved rural stroke care.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- A rural-urban disparity in thrombolytic therapy for ischemic stroke is suspected.
- This study investigates guideline-recommended stroke care and outcomes in rural hospitals to identify areas for enhancement.
Purpose of the Study:
- To compare thrombolysis rates, treatment speed, secondary stroke prevention metrics, and outcomes between rural and urban hospitals.
- To identify specific targets for improving stroke care in rural settings.
Main Methods:
- Retrospective cohort study of adult patients treated for acute ischemic stroke (2017-2019).
- Utilized Get With The Guidelines-Stroke registry data.
- Employed multivariable mixed-effect logistic regression to adjust for patient, hospital, and stroke severity factors.
Main Results:
- Rural stroke centers had lower thrombolysis rates (31.7% vs. 43.5%) and slower door-to-needle times (33% vs. 44.7% ≤45 min) compared to urban stroke centers.
- Rural stroke centers demonstrated comparable secondary stroke prevention metrics to urban stroke centers.
- Rural stroke centers outperformed rural non-stroke centers in thrombolysis rates, treatment speed, and secondary prevention.
Conclusions:
- Rural hospitals exhibit lower thrombolytic utilization and slower treatment initiation for ischemic stroke than urban counterparts.
- Rural stroke centers achieve secondary stroke prevention comparable to urban centers, surpassing rural non-stroke facilities.
- Findings underscore critical opportunities for targeted rural health equity interventions in stroke care.
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