Abstract 148: Age Disparities in Acute Stroke Treatment: An Analysis of Six Years of US Hospital Discharges

Abstract

Introduction: For each decade beyond age 55, the risk of ischemic stroke more than doubles; however, studies suggest that the elderly may receive acute treatments less frequently. Recently, several trials have shown benefit for endovascular thrombectomy (IA). Many of these trials included elderly patients. It remains unclear if previously described age disparities will continue to be seen as strategies for acute stroke therapy evolve. The purpose of this analysis was to establish the proportion of older adults that received acute revascularization treatment prior to the publication of these new endovascular trials. Methods: We used the National Inpatient Sample to obtain data on primary ischemic stroke diagnosis discharges from US hospitals between 2006 to 2011. Among these discharges, utilization of IV tPA or endovascular thrombectomy was identified using procedure codes. Discharges were further classified by age ≥75 and year. Results: Over the 6 year period, nearly half (47%) of the 2,592,269 ischemic stroke discharges were age 75 or older. Despite this, they represented only 27% of tPA administrations and 34% of endovascular procedures (Figure 1). For all ischemic stroke discharges during this period, tPA was administered in a lower proportion of patients ≥75 years compared to those <75 (3.7% [95% CI 3.5-4.0] vs. 4.5% [95% CI 4.3-4.8%]). Both tPA utilization and endovascular procedures increased each year for all age groups (p<0.001, Figure 1). Conclusions: Despite the fact that approximately half of stroke discharges were age 75 or older, they account for only about 30% of those receiving acute stroke therapies. As the US population ages, these findings raise concern that fewer older patients will receive the only acute therapies shown to improve functional outcome in ischemic stroke. Providers should be cognizant of potential age biases when selecting candidates for acute therapy and should continue to enroll the elderly in therapeutic trials.