Rural Stroke Patients are Less Likely to Receive Life-Saving Thrombectomy
Summary
- Dr. Dileep Yavagal led a study that found rural stroke patients are 15% less likely to receive thrombectomy.
- Dr. Yavagal’s research team studied a dataset of more than 24,000 stroke patients, comparing urban and rural patients.
- Rural hospitals are often not equipped for thrombectomy, but Dr. Yavagal believes they can make preparations that will improve stroke patient outcomes.
Timing is critical in emergency stroke care. So is where you live, a University of Miami Miller School of Medicine stroke expert found.
While stroke patients in urban areas often receive timely thrombectomy, new research shows patients in rural U.S. areas are 15% less likely to receive thrombectomy.
Dileep Yavagal, M.D., chief of interventional neurology and professor of clinical neurology and neurosurgery at the Miller School, is the senior author of the Stroke: Vascular and Interventional Neurology study.
“We suspected the lack of rapid access to thrombecotmy in rural areas would be a major impediment towards stroke treatment,” Dr. Yavagal said. “However, there was no data on this till now. Our study is a significant accomplishment, as the data we gathered confirms our concerns and provides the necessary foundation to further explore the reasons behind the treatment gap.”
Big Data Analysis Reveals Stroke Care Gaps
Large vessel occlusion (LVO) stroke is the most severe type of ischemic stroke and contributes to most stroke morbidity and mortality. Once emergency thrombectomy became the standard of care for stroke patients in 2015, researchers at the Miller School looked at barriers to accessing the treatment on a global level.
“As we studied barriers to access, the whole rural aspect started to come up repeatedly,” Dr. Yavagal said. “It started to become clear that rural America may be one of the most underserved areas for this very beneficial treatment, and it was necessary to further explore why this is the case.”
Dr. Yavagal and first author Amanda Jagolino-Cole, M.D., an alumnus of the Miller School neurology residency program, used the Get with the Guidelines database in their research. The team looked at a dataset of 24,600 stroke patients around the country, comparing the rates of thrombectomy in rural and urban patients who were transferred by the presenting hospitals to a certified stroke center. The researchers adjusted the analysis for the severity of stroke, other demographics and social determinants of health.
“When we compared the rates of thrombectomy in rural to non-rural patients to see if our hypothesis was correct, we found a 15% lower chance of rural patients getting this life-saving therapy,” Dr. Yavagal said. “While this news wasn’t shocking, it was extremely important, as it provided evidence for the first time for a significant disparity in patients getting this highly beneficial treatment. It sets the foundation to boost research efforts and the allocation of resources to overcome this major health disparity.”
Taking Steps to Improve Stroke Outcomes
Thrombectomy is most effective when administered within six hours of stroke, and no more than 24 hours after stroke. While the dataset doesn’t reveal the reason for the discrepancy, Dr. Yavagal suspects the time that elapses between presentation in a rural hospital and arrival at the stroke center could be an important factor. This hypothesis needs more study to account for the precise details of patient movement from hospital to stroke center.
Performing thrombectomy in rural hospitals is not pragmatic, as it requires specialized angiography equipment and highly skilled personnel. But Dr. Yagaval believes these hospitals can take deliberate steps to benefit stroke patients.
“Rural hospitals need to have an established network of transfer agreements with several thrombectomy hospitals ahead of time,” Dr. Yavagal said. “They also need to quickly assess when a patient is having a stroke and not confuse symptoms with nausea, drug overdose or a fall. Lastly, they need access to rapid neuroimaging and telestroke services for quick diagnosis and administration of intravenous clot busting medication, if appropriate for the patient, before transfer for thrombectomy.”
Tags: Department of Neurology, Dr. Dileep Yavagal, neurology, stroke, stroke outcomes, thrombectomy