Abstract 183: Predictors of Good Functional Outcome at Discharge in Stroke Patients with Depression in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study

Abstract

Background: Stroke is the fifth leading cause of death in the US and results in major disability. Modifiable factors that increase risk of poor outcome need to be identified. Depression is related to worse post-stroke outcomes with Hispanics having a higher burden of stroke and depression than non-Hispanics. The goal of this study was to determine the effect of ethnicity and prior depression on post-stroke outcomes. Methods: We analyzed 80,687 cases (84 institutions) from the FL-PR Stroke Registry (2014-2017). Pre-existing depression was identified by prior history or use of anti-depressant medications. Univariate analyses of patient characteristics (age, race/ethnicity, insurance), medical history [prior stroke/TIA, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, tobacco, peripheral vascular disease (PVD), atrial fibrillation (AF), heart failure (HF), and chronic renal insufficiency (CRI)], mode of arrival, initial stroke severity (NIHSS), and independent ambulation prior to stroke, and multilevel multivariate logistic regressions using discharge modified Rankin Score (mRS) and ambulatory status were developed. Results: Of 80,687 cases analyzed, 10,085 (12.5%) had depression: 15% white, 7% black, 11% Florida Hispanic, 7% Puerto Rico Hispanic. In multivariate models, depression decreased the likelihood of good clinical outcomes (mRS 0-2, OR: 0.85, 95% CI 0.78, 0.92; independent ambulation at discharge, OR: 0.86, 95% CI 0.80, 0.94). Age ≥65, black, female, Medicare, no insurance or Medicaid, NIHSS ≥5, prior stroke/TIA, HTN, DM, AF, PVD, HF, CRI, and arrival by EMS were negatively associated with mRS 0-2; whereas dyslipidemia and premorbid independent ambulation showed positive association (p<0.05). Age ≥ 65, black, female, Medicare, initial NIHSS ≥ 5, history of stroke or TIA, HTN, DM, PVD, HF, CRI, and arrival via EMS were negatively associated with independent ambulation at discharge; whereas history of dyslipidemia or being a smoker and independent ambulation prior to stroke showed a positive association (p<0.05). Conclusions: Pre-stroke depression adversely affected functional outcomes at discharge. Various comorbidities also negatively impacted functional outcome, whereas independent ambulation and dyslipidemia prior to stroke increased likelihood of good outcome. Future studies should evaluate if antidepressant medications and intensive management of risk factors improve delayed outcomes.