Cited by 292Acute Ischemic Stroke ManagementAcute Myocardial Infarction ResearchCerebrovascular and Carotid Artery Diseases

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Race/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke

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Schwamm, Lee H., Reeves, Mathew J., Pan, Wenqin, Smith, Eric E., Frankel, Michael R., Olson, DaiWai, Zhao, Xin, Peterson, Eric, Fonarow, Gregg C.·2010·Circulation

DOI 10.1161/circulationaha.109.881490

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Abstract

Background— Prior studies suggest differences in stroke care associated with race/ethnicity. We sought to determine whether such differences existed in a population of black, Hispanic, and white patients hospitalized with stroke among hospitals participating in a quality-improvement program. Methods and Results— We analyzed in-hospital mortality and 7 stroke performance measures among 397 257 patients admitted with ischemic stroke to 1181 hospitals participating in the Get With The Guidelines-Stroke program 2003 through 2008. Relative to white patients, black and Hispanic patients were younger and more often had diabetes mellitus and hypertension. After adjustment for both patient- and hospital-level variables, black patients had lower odds relative to white patients of receiving intravenous thrombolysis (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77 to 0.91), deep vein thrombosis prophylaxis (OR, 0.88; 95% CI, 0.83 to 0.92), smoking cessation (OR, 0.85; 95% CI, 0.79 to 0.91), discharge antithrombotics (OR, 0.88; 95% CI, 0.84 to 0.92), anticoagulants for atrial fibrillation (OR, 0.84; 95% CI, 0.75 to 0.94), and lipid therapy (OR, 0.91; 95% CI, 0.88 to 0.96), and of dying in-hospital (OR, 0.90; 95% CI, 0.85 to 0.95). Hispanic patients received similar care as their white counterparts on all 7 measures and had similar in-hospital mortality. Black (OR, 1.31; 95% CI, 1.28 to 1.35) and Hispanic (OR, 1.16; 95% CI, 1.11 to 1.20) patients had higher odds of exceeding the median length of hospital stay relative to whites. During the study, quality of care improved in all 3 race/ethnicity groups. Conclusions— Black patients with stroke received fewer evidence-based care processes than Hispanic or white patients. These differences could lead to increased risk of recurrent stroke. Quality of care improved substantially in the Get With The Guidelines-Stroke Program over time for all 3 racial/ethnic groups.

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Authors: Schwamm, L. H., Reeves, M. J., Pan, W., Smith, E. E., Frankel, M. R., Olson, D., Zhao, X., Peterson, E., & Fonarow, G. C.
Affiliations: Emory University (US)
ORCID: Schwamm, Lee H.
Reeves, Mathew J.
Smith, Eric E.
Frankel, Michael R.
Olson, DaiWai
Zhao, Xin
Peterson, Eric
Fonarow, Gregg C.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-04-06
Volume: 121
Issue: 13
Pages: 1492-1501
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.109.881490
OpenAlex: W2074386052
Cited by: 292
References: 42
Citations by year: 2026: 8 · 2025: 21 · 2024: 29 · 2023: 26 · 2022: 17 · 2021: 19 · 2020: 10 · 2019: 11 · 2018: 8 · 2017: 18 · 2016: 19 · 2015: 20 · 2014: 17 · 2013: 23 · 2012: 13
FWCI: 15.94
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: American Heart Association
Pfizer
American Stroke Association
Centers for Disease Control and Prevention
National Institute of Neurological Disorders and Stroke
Topics: Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords: ischemic stroke, racial disparities, ethnic disparities, quality of care, Black patients, Hispanic patients, Caucasian patients, intravenous thrombolysis, deep vein thrombosis prevention, smoking cessation, antithrombotic therapy, atrial fibrillation anticoagulation, lipid therapy, in-hospital mortality, length of hospital stay, Get With The Guidelines-Stroke, evidence-based care
MeSH terms: Aged, Aged, 80 and over, Black or African American, Brain Ischemia, Female, Hispanic or Latino, Humans, Male, Middle Aged, Quality of Health Care, Registries, Risk Factors, United States, Thrombolytic Therapy, Hospital Mortality, Stroke, Black People, White People, Racial Groups

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Race/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke

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