TY - JOUR
T1 - Disparities and Trends in Door-to-Needle Time
T2 - The FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities)
AU - Oluwole, Sofia A.
AU - Wang, Kefeng
AU - Dong, Chuanhui
AU - Ciliberti-Vargas, Maria A.
AU - Gutierrez, Carolina M.
AU - Yi, Li
AU - Romano, Jose G.
AU - Perez, Enmanuel
AU - Tyson, Brittany Ann
AU - Ayodele, Maranatha
AU - Asdaghi, Negar
AU - Gardener, Hannah
AU - Rose, David Z.
AU - Garcia, Enid J.
AU - Zevallos, Juan Carlos
AU - Foster, Dianne
AU - Robichaux, Mary
AU - Waddy, Salina P.
AU - Sacco, Ralph L.
AU - Rundek, Tatjana
N1 - Funding Information:
The FL-PR CReSD study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) is supported by the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (NINDS) and Stroke Prevention and Intervention Research Program (SPIRP) cooperative grant (grant number: U54NS081763). The women's supplement is awarded from the Office of Research on Women's Health (grant Number: 3U54NS081763-01S1).
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background and Purpose-In the United States, about half of acute ischemic stroke patients treated with tPA (tissue-type plasminogen activator) receive treatment within 60 minutes of hospital arrival. We aimed to determine the proportion of patients receiving tPA within 60 minutes (door-to-needle time [DTNT] ≤60) and 45 minutes (DTNT ≤45) of hospital arrival by race/ethnicity and sex and to identify temporal trends in DTNT ≤60 and DTNT ≤45. Methods-Among 65 654 acute ischemic stroke admissions in the National Institute of Neurological Disorders and Stroke-funded FL-PR CReSD study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) from 2010 to 2015, we included 6181 intravenous tPA-treated cases (9.4%). Generalized estimating equations were used to determine predictors of DTNT ≤60 and DTNT ≤45. Results-DTNT ≤60 was achieved in 42% and DTNT ≤45 in 18% of cases. After adjustment, women less likely received DTNT ≤60 (odds ratio, 0.81; 95% confidence interval, 0.72-0.92) and DTNT ≤45 (odds ratio, 0.73; 95% confidence interval, 0.57-0.93). Compared with Whites, Blacks less likely had DTNT ≤45 during off hours (odds ratio, 0.68; 95% confidence interval, 0.47-0.98). Achievement of DTNT ≤60 and DTNT ≤45 was highest in South Florida (50%, 23%) and lowest in West Central Florida (28%, 11%). Conclusions-In the FL-PR CReSD, achievement of DTNT ≤60 and DTNT ≤45 remains low. Compared with Whites, Blacks less likely receive tPA treatment within 45 minutes during off hours. Treatment within 60 and 45 minutes is lower in women compared with men and lowest in West Central Florida compared with other Florida regions and Puerto Rico. Further research is needed to identify reasons for delayed thrombolytic treatment in women and Blacks and factors contributing to regional disparities in DTNT.
AB - Background and Purpose-In the United States, about half of acute ischemic stroke patients treated with tPA (tissue-type plasminogen activator) receive treatment within 60 minutes of hospital arrival. We aimed to determine the proportion of patients receiving tPA within 60 minutes (door-to-needle time [DTNT] ≤60) and 45 minutes (DTNT ≤45) of hospital arrival by race/ethnicity and sex and to identify temporal trends in DTNT ≤60 and DTNT ≤45. Methods-Among 65 654 acute ischemic stroke admissions in the National Institute of Neurological Disorders and Stroke-funded FL-PR CReSD study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) from 2010 to 2015, we included 6181 intravenous tPA-treated cases (9.4%). Generalized estimating equations were used to determine predictors of DTNT ≤60 and DTNT ≤45. Results-DTNT ≤60 was achieved in 42% and DTNT ≤45 in 18% of cases. After adjustment, women less likely received DTNT ≤60 (odds ratio, 0.81; 95% confidence interval, 0.72-0.92) and DTNT ≤45 (odds ratio, 0.73; 95% confidence interval, 0.57-0.93). Compared with Whites, Blacks less likely had DTNT ≤45 during off hours (odds ratio, 0.68; 95% confidence interval, 0.47-0.98). Achievement of DTNT ≤60 and DTNT ≤45 was highest in South Florida (50%, 23%) and lowest in West Central Florida (28%, 11%). Conclusions-In the FL-PR CReSD, achievement of DTNT ≤60 and DTNT ≤45 remains low. Compared with Whites, Blacks less likely receive tPA treatment within 45 minutes during off hours. Treatment within 60 and 45 minutes is lower in women compared with men and lowest in West Central Florida compared with other Florida regions and Puerto Rico. Further research is needed to identify reasons for delayed thrombolytic treatment in women and Blacks and factors contributing to regional disparities in DTNT.
KW - achievement
KW - ethnicity
KW - healthcare disparities
KW - quality improvement
KW - race
KW - risk factors
KW - stroke
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U2 - 10.1161/STROKEAHA.116.016183
DO - 10.1161/STROKEAHA.116.016183
M3 - Article
C2 - 28706119
AN - SCOPUS:85023768587
VL - 48
SP - 2192
EP - 2197
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 8
ER -