GWTG Analysis Finds Racial Disparities Persist in Stroke Treatment as More Patients Receive Mechanical Thrombectomy

March 19, 2021—Mechanical thrombectomy is increasing, but racial differences in treatment persist according to a study funded by the Get With The Guidelines (GWTG)—Stroke initiative of the American Heart Association(AHA)/American Stroke Association (ASA).

These findings were revealed in a late-breaking science presentation at ASA’s International Stroke Conference 2021, held virtually March 17-19, 2021.

As noted in the ASA announcement, several major clinical trials confirmed in 2015 that endovascular therapy effectively treated ischemic stroke. In 2018, the AHA’s stroke treatment guidelines were updated to recommend endovascular therapy to improve the odds that certain stroke patients could have functional recovery. However, previous research has indicated members of some underrepresented racial/ethnic groups are less likely to receive recommended treatments such as endovascular therapy.

The current study compared the use of endovascular therapy and poststroke recovery among patients of different races/ethnicities before and after 2015. Between April 2012 and June 2019, investigators also reviewed data in the GWTG—Stroke program, which includes a large database of information about stroke treatment at hospitals across the United States. More than 2,000 hospitals have entered more than 5 million patient records into the program’s database since 2003.

As summarized in the ASA announcement, the investigators found that 14% of 302,965 potentially eligible patients received endovascular therapy, and in all groups, endovascular therapy increased over the course of the study. However, Black patients were 32% less likely to receive endovascular therapy before 2015 and still 17% less likely to receive it after 2015 when compared to non-Hispanic White patients.

Additionally, differences emerged related to stroke recovery. In terms of short-term outcomes, patients from underrepresented racial and ethnic groups fared better than non-Hispanic White patients. Black, Hispanic, and Asian patients were more likely to return home and less likely to die while hospitalized or be discharged to hospice care. However, 3 months later, 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.

“It is reassuring that the treatment gap for Black patients has narrowed since 2015, yet it remains significant and is concerning,” commented the study’s lead author Faheem G. Sheriff, MD, in the ASA announcement. “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. 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.”

Dr. Sheriff, who is Assistant Professor of Neurology at Texas Tech University Health Science Center in El Paso, Texas, continued, “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 postdischarge care.”