Abstract T MP71: Evaluation of a Community-Wide Stroke Preparedness Intervention: Results of the ASPIRE Study

Abstract

Background: Lack of education about stroke preparedness and needed action, particularly in underserved communities may prevent seeking timely care. Aim: To evaluate the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project. Methods: ASPIRE is a multi-level program [individual/community, hospital, EMS] using a community-engaged approach to stroke preparedness targeted to underserved black DC communities. The aim is to decrease acute stroke (AS) presentation times and increase intravenous tissue plasminogen activator (IV tPA) use. Phase 1 included 1) Enhancement of EMS focus on AS; 2) Implementation/enrichment of AS protocols to move DC hospitals to Primary Stroke certification; 3) Pre-intervention (PRE) AS patient data collection in all 7 acute care DC hospitals; 4) Focus group/survey identification of barriers to emergency stroke care to create a culturally tailored intervention. Phase 2 was a 1 year city-wide intervention. Phase 3 was 1 year post-intervention (POST) acute stroke data collection to assess changes in IV tPA use and AS presentation time. We compare PRE vs. POST AS parameters among ischemic stroke cases that arrived within 168 hours of stroke onset, excluding hospital transfers (n=84). We performed logistic regression models for AS arrival ≤ 3 hours. Results: Phase 1 identified 687 ischemic stroke cases, 85% black, 58% women; 56% ≥ 65 yrs. Phase 2 conducted 531 community interventions for 10,256+ participants; performed 3,289 intervention evaluations; distributed 19,000 preparedness bracelets and 14,000 stroke warning magnets. In Phase 3, we identified 684 ischemic stroke cases, 79% black, 58% women; 56% ≥ 65 yrs. We report significant increases in AS arrival time ≤ 3 hours (14% to 27%; p<0.0001) and in IV tPA use (4% to 9%; p<0.001). In a logistic model, significant predictors of ED arrival ≤ 3 hours included (OR; 95% CI): POST vs. PRE (1.8; 1.4 - 2.4); White vs. Black (2.0; 1.8 -2.8); Male (1.3: 1.0 -1.8); and EMS (3.6: 2.5 - 5.0). Conclusion: ASPIRE shows significant success increasing the proportion of AS arrivals to ED ≤ 3 hours and increasing IV tPA utilization. Culturally tailored community interventions can be effective in increasing stroke preparedness in underserved urban communities.