Top Things to Know: Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control
Prepared by Anne Leonard MPH, BSN, RN – National Senior Director Science and Medicine
- Stroke is a disease of disparities with racial and ethnic inequities in incidence, prevalence, treatment, and outcomes with accumulating literature on the relationship between stroke and social determinants of health (SDOH).
- Several interventions have been developed and tested to help reduce racial and ethnic disparities in stroke preparedness, care, recovery, and risk factor control but no common framework has been used to compare the interventions for effectiveness; these are discussed in this paper.
- Stroke inequities are mainly driven by many SDOH, the conditions in which people are born, grow, work, live and age.
- Underrepresented populations are not well represented in stroke clinical trials which limits the understanding of inequities, reduces the generalizability of findings, and exacerbates inequities. Equitable participation in research is paramount to understanding responses to treatment in these populations.
- This statement discusses the pre-hospital strategies to reduce inequities in underrepresented populations and points out (demonstrates/identifies?) that they are less likely to present to the emergency department within the 3 hours of acute stroke treatment with alteplase or endovascular treatment and to use emergency medical services. This paper suggests that more research in this area is needed to understand upstream determinants such as access to care or health care coverage.
- Other areas examined in this statement highlighting issues related to inequities in stroke care include:
- Acute care delivery with telehealth.
- Use of Artificial intelligence and machine learning in clinical decision making in acute care delivery.
- Diagnostic evaluation and initiation of secondary prevention during the acute stroke hospital stay.
- This statement also explores the strategies to reduce inequities in access to rehabilitation, recovery, and community reintegration.
- Strategies to reduce inequities in transitions of care or the timely and safe movement of a patient from one care setting to another are also addressed in this statement.
- Risk factor control is important after a stroke. Strategies to reduce inequities related to risk factor control are explored in this paper. Potential intervention areas discussed are at the patient-level, group-based which are culturally relevant, multi-level (individual visits with an advanced practice professional/clinician), group clinics, patient report cards on control of risk factors, self-management support, and population- based interventions.
- This scientific statement gives clinicians and researchers concepts to consider when working with historically underrepresented racial and ethnic populations to reduce inequities in stroke care on several levels.
Citation
Towfighi A, Boden-Albala B, Cruz-Flores S, El Husseini N, Odonkor CA, Ovbiagele B, Sacco RL, Skolarus LE, Thrift AG; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; and Council on Peripheral Vascular Disease. Strategies to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factorcontrol: a scientific statement from the American Heart Association [published online ahead of print May 15, 2023]. Stroke. doi: 10.1161/STR.0000000000000437