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Differences in In-Hospital and Post-Discharge Ischemic Stroke Care According to Prestroke Functional Status.

Paul M Wechsler1, Eva A Mistry1, Heidi Sucharew1

  • 1University of Cincinnati OH USA.

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Patients with prestroke disability received less acute ischemic stroke reperfusion therapy and evaluation. However, they were more likely to receive rehabilitation services. Further research is needed to optimize care for this population.

Keywords:
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Area of Science:

  • Neurology
  • Public Health
  • Health Services Research

Background:

  • Limited data exist on disparities in ischemic stroke care for patients with prestroke disability.
  • This study investigates differences in care across the continuum for patients with and without prestroke disability.

Purpose of the Study:

  • To compare in-hospital and postdischarge ischemic stroke care between patients with and without prestroke disability.
  • To identify potential gaps in stroke cause evaluation and treatment for individuals with prior functional impairment.

Main Methods:

  • Population-based study of adult ischemic stroke patients hospitalized between January 1, 2015, and December 31, 2015.
  • Used univariate analyses and logistic regression to compare reperfusion therapies, stroke cause evaluation, secondary prevention, and rehabilitation.
  • Defined prestroke disability using the modified Rankin Scale score (≥2 vs. 0-1).

Main Results:

  • Prestroke disability was associated with significantly lower odds of receiving thrombolysis and endovascular thrombectomy.
  • Patients with prestroke disability were less likely to undergo complete in-hospital stroke cause evaluation.
  • While antiplatelet and statin prescriptions showed minimal differences, those with prestroke disability received more in-hospital and postdischarge rehabilitation.

Conclusions:

  • Prestroke disability is linked to reduced acute ischemic stroke interventions and diagnostic evaluations.
  • Disparities in acute care require further investigation to understand decision-making factors.
  • Optimizing the full spectrum of ischemic stroke care for patients with prestroke disability is crucial.