Despite Improvements, Racial Disparities in EVT Care Still Exist

March 23, 2021
Marco Meglio
Marco Meglio

Marco Meglio, Associate Editor for NeurologyLive, has been with the team since October 2019. Follow him on Twitter @marcomeglio1 or email him at mmeglio@neurologylive.com

Black patients were 16% less likely and Asian patients were 30% less likely to be able to function independently compared to non-Hispanic white patients following endovascular treatment.

Findings from the Get With The Guidelines (GWTG)-stroke clinical trial demonstrated that endovascular therapy (EVT) utilization has increased across all race/ethnic groups since the treatment was validated in 2015, but disparities still remain.1

The research was presented at the American Stroke Association’s International Stroke Conference 2021, March 17-19, by lead author Faheem G. Sheriff, MD, assistant professor of neurology, Texas Tech University Health Science Center. Between April 2012 and June 2019, 14% (n = 42,422) of a cohort of 302,965 potentially eligible patients received EVT and, in all groups, EVT increased over the course of time.

Despite these increases, Black patients were 32% less likely to receive EVT before 2015 (odds ratio [OR], 0.68 [95% CI, 0.58-0.78]; P <.001) and still 17% less likely to receive it from 2015 on (OR, 0.83 [95% CI, 0.76-0.90]; P <.0001) when compared to non-Hispanic White (NHW) patients (P = .0187).

"It is reassuring that the treatment gap for Black patients has narrowed since 2015, yet it remains significant and is concerning. The most surprising finding was the discrepancy between short- and long-term outcomes in non-Hispanic White patients versus the patients in other race and ethnicity groups,” Sheriff said in a statement.2

READ MORE: American Heart Association Releases Results on COVID-19 and Stroke Characteristics, Prevalence

The use of EVT increased in 2015 following the publication of multiple clinical trials. Associations between race/ethnicity, EVT use, discharge disposition, and 90-day modified Rankin Scale (mRS) scores stratified by pre- vs. post-2015 were evaluated (with the post-2015 group including 2015).

Sheriff and colleagues also found that minority patients had more favorable short-term outcomes compared to NHW patients from 2015 on. Additionally, less frequent in-hospital mortality/ discharge was observed in Black (adjusted odds ratio [aOR], 0.61; P <.0001), Hispanic (aOR, 0.77; P <.0001) and Asian (aOR, 1.28; P <.001) patients compared to NHW patients.

At discharge, both mRS and ambulation were no different between the groups. Better short-term outcome among minorities was attributed to improving access to acute stroke care following the 2015 publications, as well as different attitudes towards end-of-life care among NHW compared with minorities.Although, 3 months later, Black and Asian patients were 16% and 30% less likely to be able to function independently compared to NHW patients.

There were a number of contributory factors for these disparities identified. They included systemic racism (structural vs provider level), lower utilization of emergency medical services (EMS) and later arrival to EVT capable centers, lack of awareness regarding acute stroke symptoms, and mistrust of the health care system likely due to historic inequalities.

"There is a lot of work that remains in terms of figuring out the root causes for these differences and how best to improve equitable access and care for all patients,” Sheriff added. “Once these root causes are identified, we can focus on formulating an action plan to reduce these differences, for both access to endovascular therapy and recovery afterwards, particularly post-discharge care.”

For more coverage of ISC 2021, click here.

REFERENCE
1. Sheriff F, Cruz-Flores S, Fonarow GC, et al. National temporal trends in endovascular therapy (EVT) utilization and outcomes according to race and ethnicity: findings from Get With the Guidelines (GWTC)-stroke. Presented at International Stroke Conference 2021; March 17–19. Abstract LB 9.
2. More stroke patients receiving mechanical clot removal, yet racial disparities persist. News release. American Stroke Association. March 19, 2021. Accessed March 22, 2021. https://newsroom.heart.org/news/more-stroke-patients-receiving-mechanical-clot-removal-yet-racial-disparities-persist?preview=e2c2