Patent Foramen Ovale Closure in hospitalized stroke patients in the United: Is there a racial disparity?

Abstract

Background Racial disparity in stroke is well documented. Whether such disparity exists in the frequency of Patent Foramen Ovale (PFO) closure among patients with ischemic stroke (IS) is unclear. Objective To investigate the rate, trends, and racial determinants of PFO closure among hospitalized patients with ischemic stroke in the U.S. Methods The Nationwide Inpatient Sample was queried from 2006 to 2014 for patients older than 18-years of age with a primary discharge diagnosis of IS excluding those with a secondary discharge diagnosis of congenital heart diseases other than PFO. Patients were categorized by their PFO closure status. First, we determined the rate and 9-year trend in the rate of PFO closure. We then performed a logistic regression analysis to study the independent association between race and PFO closure. Results We identified a total of 1,028,565 patients with a primary discharge diagnosis of ischemic stroke, of whom 384 had PFO closure. In univariate analysis, PFO closure was more likely to be performed in younger patients, Hispanic patients, privately insured patients, those seen in large bed size academic center, and in patients in the high-income categories. We also observed that the rate of PFO closure decreased overtime overall and in all races, particularly after 2010. In multivariable logistic regression, Non-Hispanic Blacks were less likely to have PFO closure (OR: 0.51, 95%, CI: 0.35-0.74) when compared to Non- Hispanic Whites meanwhile the high rate of PFO closure in Hispanics observed in the univariate model was attenuated and did not reach statistical significance (OR: 1.57, CI: 0.90-2.72). Conclusions Although the rate of PFO closure has declined over time across all races after 2010, overall, Non-Hispanic Blacks were two times less likely to have a PFO closure after ischemic stroke than Non-Hispanic Whites after adjusting for demographic and socio-economic factors.