Secondary stroke evaluation in patients admitted for CRAO in a large national inpatient sample
Sahil Doshi1, Jay B Bisen1, Hanaina K Bains1
1Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
Patients with central retinal artery occlusion (CRAO) received inadequate stroke evaluations before 2021. Higher socioeconomic status was linked to more comprehensive secondary stroke prevention assessments for CRAO patients.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Central retinal artery occlusion (CRAO) is linked to cerebrovascular ischemia.
- The 2021 American Heart Association (AHA) statement recommends stroke evaluations for CRAO patients.
- Previous stroke evaluation rates for CRAO prior to 2021 are not well understood.
Purpose of the Study:
- To assess national stroke evaluation rates in patients diagnosed with CRAO before the 2021 AHA guidelines.
- To identify patterns and predictors of stroke evaluations in CRAO patients.
Main Methods:
- Retrospective analysis of inpatient admissions (2016-2021) from the National Inpatient Sample.
- Measured completion rates of echocardiograms, head/neck vessel imaging, and temporal artery biopsies for CRAO admissions.
- Utilized clustering analysis to characterize patient groups and their evaluation patterns.
Main Results:
- Out of 9615 CRAO admissions, only 0.3% had carotid ultrasounds, 10% had echocardiograms, and 8.5% had cerebrovascular imaging.
- Echocardiograms (10%) and temporal artery biopsies (6.4%) were the most frequent evaluations.
- Clustering revealed distinct groups: older females (often on Medicare) receiving biopsies, and younger males receiving echocardiograms/imaging and discharged home.
- Higher income, female sex, transfer status, concurrent cerebral stroke, carotid atherosclerosis, and nicotine dependence predicted increased evaluation rates.
Conclusions:
- National stroke evaluation rates for CRAO patients were low prior to the 2021 AHA guidelines.
- Patients with higher socioeconomic status were more likely to receive comprehensive stroke evaluations.
- Findings highlight disparities in secondary stroke prevention for CRAO.
Background:
Central retinal artery occlusion (CRAO) is an ophthalmic condition associated with cerebrovascular ischaemia. In patients with acute CRAO, the 2021 American Heart Association (AHA) scientific statement recommends a diagnostic evaluation for secondary stroke prevention, including cerebrovascular imaging, cardiac rhythm monitoring, echocardiogram and labs. This study aims to understand the national stroke evaluation rates for patients with CRAO before 2021.
Methods:
Retrospective, cross-sectional analysis of inpatient admissions from the National Inpatient Sample between 2016 and 2021. Echocardiogram, head and neck vessel imaging and temporal artery biopsy completion during hospital admissions with a principal diagnosis of CRAO were measured. Clustering analysis was performed to characterise differences in stroke evaluations.
Results:
9615 inpatient stays for CRAO were identified. Only 0.3% underwent carotid ultrasounds, 10% underwent echocardiograms, and 8.5% underwent cerebrovascular imaging. Echocardiograms (10%) were most frequently performed, followed by temporal artery biopsy (6.4%). Clustering analysis reveals a cluster of older females on non-Health Maintenance Organisation Medicare receiving temporal artery biopsies. Other clusters consisted of younger males, who were more likely to receive an echocardiogram or cerebrovascular imaging and be discharged home. Independent predictors increasing the odds of undergoing stroke evaluations include female sex, transfer from another facility, residence in zip codes with a median household income of >$79 000, concurrent diagnosis of cerebral stroke, carotid atherosclerosis and nicotine dependence through cigarette use.
Conclusions:
In this national cohort study, low percentages of patients with CRAO were evaluated for secondary stroke prevention before the 2021 AHA scientific statement on CRAO management. Notably, higher socioeconomic status patients underwent more comprehensive stroke evaluations.
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