Abstract WP87: Sex-based Variation In Acute Stroke Care Via Telestroke

Abstract

Objective: Assess for treatment differences by sex and their potential contributors among telestroke evaluations. Background: Studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR as low as 0.57 reported and worse outcomes. With improved access to care through telestroke and updated standards of care, there is potential to reduce or alleviate these disparities. Methods: Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare TM database. The encounters were reviewed for age, sex, last known normal (LKN), arrival time, consult call time, needle time, thrombolytics candidate, premorbid modified Rankin Score (p-mRS), NIHSS score, screen time, stroke risk factors (hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, coronary artery disease and previous stroke), antithrombotic use, admitting diagnosis of stroke, and reason not treated with thrombolytic. The treatment rates, Door-to-needle (DTN) times, and variables of treatment were compared for females and males. Results: There were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75-0.97, p=0.006). Median DTN times were shorter for males (38 minutes) than females (41 minutes), p<0.001. Male patients were more likely to have an admitting diagnosis of stroke, p <0.001. Female patients <50 and ≥80 years of age were treated at a higher rate than males, while males 50-79 were treated at a higher rate than females. Multivariate analysis of the 50-79 age group did not show a difference in the thrombolytics treatment rates (female 7.6% and male 8.3%, p= 0.752), but did show males had higher rates of all stroke risks factors. Conclusion: While the overall lower treatment rate for females in univariate analysis was consistent with previous studies, the difference was not seen in multivariate analysis. The treatment differences between males and females were negated once the significant sex-based differences in stroke risk factors are taken into consideration.