Introduction: Treatment with intravenous tissue plasminogen activator (IV tPA) and/or mechanical thrombolysis can improve outcomes in ischemic stroke. We examined use of these interventions as it pertains to regional, demographic, and socioeconomic factors.

Methods: We queried the National Inpatient Sample (NIS) for all hospital admissions for ischemic stroke in the United States from 2005 to 2009. Patients less than 18 years of age were excluded. We then searched this subset of hospital admissions for those treated with either IV tPA, mechanical thrombolysis, or both. Results were correlated with demographics in an attempt to define nationwide trends pertaining to access to acute stroke care.

Results: Of all admissions for ischemic stroke, 3.34% underwent an acute stroke intervention. Stroke admissions were highest in the South region at 140,149. In the Midwest, West, and Northeast, admissions were 76,378; 61,753; and 57,942; respectively. The percentage of ischemic stroke admissions that received acute stroke intervention was highest in the Northeast region at 4.24, followed by West: 3.87, Midwest: 3.21, and South: 2.86 (p < 0.001). For teaching hospitals the percentage of interventions was 4.91 versus 2.27 (p < 0.001) at nonteaching hospitals. When compared to Medicaid and Medicare, those admissions funded by private insurance had a higher percentage of treatment at 4.6 versus 3.47 (p < 0.001). There was a negative correlation between age at admission and percentage of acute stroke intervention. Linear regression revealed a drop of 0.06 percentage points per year (r = -0.83).

Conclusions: Regional fluctuation in stroke intervention is likely attributable to variable medical infrastructures, availability of specially trained physicians, and general population awareness/education. The southern region seems particularly underserved in that it holds the highest incidence of ischemic stroke but the lowest rate of access to acute interventions.

Patient Care: Demonstrate opportunities for improving delivery of acute stroke care in the United States.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify disparities in acute stroke care between regions of the United States 2) Understand factors that underlie variations in acute stroke care

References: Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655-1711.