Abstract WMP92: Stroke Quality of Care Measures in Relation to Long-term Mortality in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study

Abstract

Introduction: In the FL-PR CReSD Study, there were race/ethnic disparities in the receipt of defect-free care. How race/ethnic disparities in acute stroke care contribute to disparities in outcomes after stroke is not well understood. We examined the relationship between acute stroke quality of care measures and mortality within the first year by race/ethnicity. Methods: The study included fee-for-service Medicare beneficiaries age ≥65 discharged with a primary diagnosis of ischemic stroke in 2010-2013 who were propensity matched with data from 66 CReSD hospitals in FL. Defect-free care included IV tPA treatment, in-hospital antithrombotic therapy, DVT prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, and smoking cessation counseling. We used mixed logistic models to assess the associations between stroke care and outcomes (in-hospital, 30 day, 6 month, and 1 year mortality) by race/ethnicity, adjusted for demographics and stroke severity. Results: Among 14,100 stroke patients (73% white, 12% black, 15% Hispanic), mortality was 3% in-hospital, 12% at 30d, 21% at 6m, and 26% at 1y. Compared to whites, Hispanics had a greater odds of mortality at all time points, even after adjustment for defect-free care and individual stroke care metrics. Defect-free care was only associated with a lower risk of death within the first year among blacks (OR=0.67, p=0.004). Early antithrombotic use and antithrombotic use at discharge were associated with a lower risk of mortality at all time points, and the protective association for early antithrombotic use was strongest among whites. Statin therapy at discharge was associated with decreased 6m and 1y mortality, but this association was specific to whites and blacks. Conclusions: Acute stroke process of care measures, particularly antithrombotic use and statin therapy, were associated with a reduced odds of long-term mortality, particularly among non-Hispanics. Hispanic stroke survivors were at an increased risk of death within the first year, independent of acute stroke care measures. Results underscore the importance of optimizing acute stroke care.