July 1, 2011 A Washington, D.C. citywide study published online in Stroke: Journal of the American Heart Association demonstrates racial disparities in the use of clot-busting drugs to treat acute ischemic stroke, the most common type of stroke.
According to the study's results, significantly fewer black patients receive the drug tPA than whites because of delays in seeking emergency care and the presence of medical conditions that exclude them from receiving the treatment. On the other hand, racial bias in doctors' treatment decisions do not appear to be a factor.
Amie Hsia, MD, medical director of the Stroke Center at Washington Hospital Center and assistant professor in Georgetown University's Department of Neurology, led the study that looked at 1,044 patients treated for stroke from Feb. 1, 2008 to Jan. 31, 2009 at seven acute-care hospitals in the District of Columbia.
Of the patients studied, 775 (80%) were black, and 198 (20%) were white. Only three percent of the black patients received intravenous tPA, the best available treatment, versus 10 percent of the white patients. Formally known as tissue plasminogen activator, tPA has been demonstrated to improve stroke outcomes by breaking up the clot that is blocking the blood flow to the brain.
In order for tPA to be effective, a patient must be treated within three hours of the onset of symptoms and show disabling deficits such as pronounced weakness or severe speech difficulty. Additionally, patients can be ineligible for tPA if they have had a recent stroke, a history of a brain bleed or blood pressure that's too high to safely administer the treatment.
According to the study, the vast majority of black patients are ineligible for the treatment once they arrive at the hospital in large part because of the delay in seeking treatment and the effects of poorly controlled stroke risk factors such as high blood pressure or a recent stroke that made them unsafe candidates for treatment. For those eligible for tPA, there were no statistical differences in the race of those who received treatment, indicating that race was not a factor in whether doctors administered tPA to eligible patients.
The study falls in line with one published online in the same journal on May 5, 2011, also from Dr. Hsia, which reveals that blacks more often called friends or family first instead of 911 when they experienced stroke symptoms, often leading to a delay in treatment and poor outcomes.
"This finding is, on one hand, reassuring to us as providers because it shows no bias on the part of those treating the patients as the reason for disparities in the administration of tPA," said Dr. Hsia. "However, it also highlights the crucial need for more effective education targeted to our urban black population on the symptoms of stroke and actions they must take in order to get proper treatment right away."
The National Institute of Neurological Disorders and Stroke and the National Center on Minority Health and Health Disparities funded the research.
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- Amie W. Hsia, Dorothy F. Edwards, Lewis B. Morgenstern, Jeffrey J. Wing, Nina C. Brown, Regina Coles, Sarah Loftin, Andrea Wein, Sara S. Koslosky, Sabiha Fatima, Brisa N. Sánchez, Ali Fokar, M. Chris Gibbons, Nawar Shara, Annapurni Jayam-Trouth, and Chelsea S. Kidwell. Racial Disparities in Tissue Plasminogen Activator Treatment Rate for Stroke: A Population-Based Study. Stroke: Journal of the American Heart Association, 2011; DOI: 10.1161/STROKEAHA.111.613828
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