Abstract Details

Title Disparities in the effect of atrial fibrillation on discharge destination and length of stay in patients hospitalized for ischemic stroke: the Florida Puerto Rico Atrial Fibrillation Stroke Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-042

Objective

To identify sex and race-ethnic disparities associated with atrial fibrillation (AF) in outcomes of patients hospitalized for ischemic stroke (IS) in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Registry.

Background

Population-based data on stroke care outcomes in diverse patients with IS and AF is scarce.

Design/Methods

The study included 104,308 IS cases at 89 hospitals from 2010-2016. Multivariable logistic regression models adjusted for clinical and hospital factors were performed to evaluate the association between AF and discharge home and hospital length of stay (LOS), overall and by sex and race-ethnicity.

Results

AF was present in 24,040 (23%) IS cases. Compared to non-AF patients, patients with AF were older (79±11 vs. 68±14 years), more women (53.8% vs. 48.4%), White (74.3% vs. 57.9%), had more severe strokes (NIHSS ≥6, 43.9% vs. 26.9%) and had greater stroke risk (CHA₂DS₂-VASc ≥4; 93.2% vs. 78.5%). AF patients were less likely discharged home (OR=0.89; 0.85–0.92), and had greater length of stay (LOS>6 days, OR=1.53; 1.46–1.60) than non-AF patients. After adjustment, the effect of AF on discharge home was greater in women (29% in AF vs. 50% in non-AF; adjusted OR=0.84, 0.80-0.88) than in men (41% in AF vs. 55% in non-AF; adjusted OR=0.94, 0.89-0.99), p-value for interaction <0.001. The effect of AF on LOS>6 days was greater in PR-Hispanics (61% in AF vs. 42% in non-AF; adjusted OR=1.91, 1.66-2.19) than in FL-whites (32% in AF vs. 22% in non-AF; adjusted OR=1.52, 1.43-1.61), FL-blacks (48% in AF vs. 31% in non-AF; adjusted OR=1.60, 1.47-1.75) and FL-Hispanics (44% in AF vs. 29% in non-AF; adjusted OR=1.57, 1.44-1.72), p-value for interaction of 0.001.

Conclusions

AF is associated with less discharge home and prolonged hospital stay in patients with IS, especially in women and PR-Hispanics. Reasons for these disparities are unclear and need further investigations.

Authors/Disclosures
Nicole B. Sur, MD (University of Miami) PRESENTER	Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
William S. Burgin, MD	Dr. Burgin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for VuEssence. Dr. Burgin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Burgin has stock in VuEssence. The institution of Dr. Burgin has received research support from VuEssence. The institution of Dr. Burgin has received research support from Bristol-Myers Squibb. The institution of Dr. Burgin has received research support from ReNeuron.
David Z. Rose, MD (USF)	Dr. Rose has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Chiesi USA. Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Boehringer Ingelheim . Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL-Behring .
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NHLBI.
	No disclosure on file
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.

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