Abstract WP85: Stroke Prevalence In Arkansas's Delta

Abstract

Background: Telestroke hospitals in the southern Arkansas Delta participating in the American Heart Associations (AHA) Get With the Guidelines® (GWTG) are challenged with medically disadvantaged, vulnerable patient populations. The Delta is largely rural with a poverty rate higher than the US National average and residents suffer a 10 year lower life expectancy of when compared to neighboring northern counties. To determine the Delta’s influence on stroke recognition and outcomes, we examined 3-digit zip code, age at stroke occurrence, race, transport mode to diagnosing hospital, patient disposition at discharge, and stroke type in calendar years (CY) 2019 to 2021. Methods: We retrospectively reviewed the AHA GWTG Stroke data for the University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) - Telestroke Program 2019 to 2021, from 47 of the Programs 58 participating hospital sites. Transport mode included transfers from other hospitals, emergency medical services (EMS) transport, or privately owned vehicle/taxi (POV). Patient age significance was determined using ANOVA and categorical differences with chi square analysis. Results: Data totals were 13,721 entries with 4,571, 4,478 and 4,672 entries by CY. Ages at stroke onset were among the lowest in the zip codes from Delta areas with a median age of 66 compared to the median age of 69 for Arkansas as a whole. Percentages of stroke among Black or African Americans were the highest in Delta areas in all CYs p=0.002, p<0.0001 and p<0.0001, respectively. Patient disposition at discharge with increased discharges home vs. hospice was significant by race at all CY’s p=0.01; =0.017; =0.012, respectively. Black or African Americans had an increased %death vs. Whites in 2021, 3.7% vs. 2.8%, respectively. Transport mode was significant in 2021 with increased percentages of EMS transport of ischemic and hemorrhagic strokes and increased POV transport of transient ischemic attacks (< 24 hours) TIAs X 2 =535; p<0.0001. Delta regions experienced a higher percentage of TIAs and ischemic strokes X 2 =836; p<0.0001. Conclusions: Delta areas remain at risk for increased stroke mortality for Black or African Americans and younger populations.