Abstract Details

Title Do Elderly Patients Receive Optimal Care at Certified Stroke Centers?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 215

Objective

Background BACKGROUND: Although studies have evaluated use of intravenous thrombolysis,gender and race-based disparities in stroke care delivery in JC certified and non-certified hospitals, there is a paucity of data about disparities associated with age.

Design/Methods DESIGN/METHODS: 5 JC-certified and 5 non-certified hospitals were selected. Dataset was analyzed to compare risk factors, delivery of acute stroke-care variables and outcomes in elderly (age>75) and non-elderly patients (age<75) in certified and non-certified centers.

Results RESULTS: 602 patient charts were reviewed. Mean age was 70.4 years. The ratios of elderly were not statistically different in certified and non-certified centers (42.7%vs49.7%,p=0.08). Among the elderly, 60.4% were males and 80.2% were Caucasians while 46.9% males, 63.9% Caucasians in non-elderly group. More elderly patients arrived by EMS (73.7%). Elderly patients were more likely to have hypertension (83.1%), atrial fibrillation (23.4%), less likely to have diabetes (26.3%), history of smoking (27.7%) and be ambulatory (49.4%) prior to admission. Delay in arrival to the hospital to be eligible for thrombolysis was more frequent among the non-elderly group(72.4%vs59.9%,p=0.001). 2.7% of the elderly patients at non-certified hospitals and 3.1% of the elderly patients at JC-certified centers received IV t-PA. However, more non-elderly patients received antiplatelets (88.8%), statins (61.2%), endovascular intervention (8.1%) compared to elderly. After adjustment for AF, there was no significant difference between two groups in JC-certified centers in antiplatelet use. Also elderly patients received statins less often at non-certified centers but not in JC-certified centers. Elderly were more likely to be DNR by day 2 and be discharged to sub-acute rehabilitation or nursing home than non-elderly patients

Conclusions CONCLUSIONS: Elderly patients arrived more often by EMS but still had poorer outcomes. Rates of thrombolysis were similar but fewer received endovascular intervention. Some secondary prevention measures were underutilized at non-certified centers in elderly patients.

Authors/Disclosures
Hardik R. Doshi, MD (VCU Health) PRESENTER	Dr. Doshi has nothing to disclose.
Pratik D. Bhattacharya, MD, MPH (International Medical Clinic)	Dr. Bhattacharya has a non-compensated relationship as a Research Advisor with Defeat MSA Alliance 501 (c) (3) that is relevant to AAN interests or activities.
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland)	Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Chaturvedi has received research support from NINDS.
Kumar Rajamani, MD, FAAN	Dr. Rajamani has nothing to disclose.
Aksel Siva, MD (Istanbul University Cerrahpasa School of Medicine)	Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ali Raif Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanovel Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abdi Ibrahim Ilac - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono . The institution of Dr. Siva has received research support from Turkish MS Society. The institution of Dr. Siva has received research support from The Scientific and Technological Research Council Of Turkey - Health Sciences Research Grants.

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