Abstract P300: Differences in Characteristics and Care Among Stroke Patients With Documented Substance Use

Abstract

Background: Despite the known increased risk of stroke occurrence due to substance use (SU), few studies focus on understanding this vulnerable population beyond incidence. The objective of this study was to examine patient characteristics and clinical outcomes among those admitted for stroke with documented substance use. Methods: Data included patients 18 years or older, discharged from two Portland, Oregon hospitals between October 2017 - May 2019 with a stroke diagnosis and documented abuse of alcohol (EtOH), cannabis (CB), methamphetamine (MA), opiates, cocaine, benzodiazepines, or Methylenedioxymethamphetamine (MDMA). Patients with SU of the three most common substances in this population, EtOH, MA and CB, were each compared to patients with any other type of SU with regard to demographics, risk factors, stroke subtypes, stroke treatment, discharge disposition and length of stay (LOS). Non parametric median tests and Pearson’s chi square tests were used. Results: Among 280 patients included, 79.3% (n=222) used EtOH, 26.8% (n=75) CB, and 24.6% (n=69) MA, with 38.7% (n=108) using more than one. Compared to patients with other SU, a greater percentage of patients with EtOH SU had dyslipidemia (56.8% vs. 31%, p=0.044). Fewer patients with EtOH SU smoked (50.0% vs 70.7%, p=0.008), were female (31.8% vs 50%, p=0.014) and received EVT (3.6% vs 12.7%. p=0.026). Patients with MA SU were younger (55 vs 63, p<.001), had a longer LOS (6 vs 4 days, p=0.022), more smoked (72.5% vs 48.3%, p=.001) and fewer had dyslipidemia (30.4% vs 47.9%, p=0.017) or depression (17.4% vs 31.8%, p=0.032). Fewer also arrived by EMS (28.8% vs. 43.1%) but more arrived by transfer (54.6% vs 33.2%) (p=0.008). Additionally, fewer patients with MA SU were admitted with ischemic stroke (66.7% vs 78.7%), but more with subarachnoid hemorrhage (14.5% vs 4.7%) (p=0.018). Only smoking (66.7% vs 49.8%, p=0.017) was significantly different between patients with CB SU and other SU groups. Conclusion: The findings of this study indicate care processes and stroke diagnosis differ among patients by specific type of SU. Strategies to address the specific care needs of patients with stroke and substance use should be explored.