Disparities and Temporal Trends in Stroke Care Outcomes in Patients with Atrial Fibrillation: The FLiPER-AF Stroke Study

Chuanhui Dong; Kefeng Wang; Marco R Di Tullio; Carolina Gutierrez; Sebastian Koch; Enid J García; Juan Carlos Zevallos; Ulises Nobo; Ryan C Martin; W Scott Burgin; David Z Rose; Jose G Romano; Jeffrey J Goldberger; Ralph L Sacco; Tatjana Rundek

doi:10.29011/2688-8734.100017

Disparities and Temporal Trends in Stroke Care Outcomes in Patients with Atrial Fibrillation: The FLiPER-AF Stroke Study

Int J Cerebrovasc Dis Stroke. 2019;2(1):117. doi: 10.29011/2688-8734.100017. Epub 2019 Jul 22.

Authors

Chuanhui Dong^{1

2}, Kefeng Wang¹, Marco R Di Tullio³, Carolina Gutierrez¹, Sebastian Koch¹, Enid J García⁴, Juan Carlos Zevallos⁵, Ulises Nobo⁶, Ryan C Martin⁷, W Scott Burgin⁸, David Z Rose⁸, Jose G Romano¹, Jeffrey J Goldberger⁹, Ralph L Sacco^{1

2}, Tatjana Rundek^{1

2}

Affiliations

¹ Department of Neurology, University of Miami Miller School of Medicine, Florida, USA.
² Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Florida, USA.
³ Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, USA.
⁴ Endowed Health Services Research Center, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
⁵ Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Florida, USA.
⁶ Hospital HIMA San Pablo, Caguas, Puerto Rico.
⁷ Department of Cardiology, University of Washington-Seattle School of Medicine, Washington, USA.
⁸ Department of Neurology, University of South Florida Morsani School of Medicine, Florida, USA.
⁹ Division of Cardiology, University of Miami Miller School of Medicine, Florida, USA.

Abstract

Background and purpose: Atrial Fibrillation (AF) is the most common cardiac cause of ischemic stroke. However, the relation between AF and stroke care outcomes in diverse populations is understudied. We aimed to evaluate sex and race-ethnic disparities associated with AF in hospital stroke outcomes utilizing data from the FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study.

Methods: The study included 104,308 ischemic stroke cases with available information on AF status enrolled in a state-wide stroke registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the association between AF and stroke outcomes and the modification effects on the associations by sex and by race-ethnicity, adjusted for socio-demographic status, vascular risk factors and stroke severity.

Results: AF was present in 23% of ischemic stroke cases. AF was associated with worse disability at discharge (OR=1.11, 95% CI, 1.04-1.18), less discharge to home (OR=0.89, 0.85-0.92), and longer length of hospital stay (LOS>6 days, OR=1.53, 1.46-1.60). Interaction analyses showed that the association between AF and less discharge to home was stronger in women than men (p for interaction <0.001), as well as in FL-whites than in FL-blacks, FL-Hispanics or PR-Hispanics (p for interaction=0.002). The association between AF and prolonged LOS was more prominent in PR-Hispanics than in FL-blacks, FL-Hispanics, or FL-whites (p for interaction <0.001). From 2010 to 2016, the effects of AF on hospital length of stay attenuated (p for interaction<0.001).

Conclusions: AF was associated with poor disability at discharge, less discharge to home, and prolonged hospital length of stay for acute stroke care. The effect of AF on length of stay attenuated over time. Sex and race-ethnic disparities were observed in the effect of AF on being less discharge to home and prolonged hospital stay. Further research is needed to identify and modify the biologic and systems of care contributors to these disparities.

Keywords: Atrial fibrillation; Disability; Discharge disposition; Disparity; Hospital care; In-hospital mortality; Length of stay; Stroke Severity.

Abstract

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