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Acute stroke patients are not managing their risk factors for diabetes, and African-American stroke patients have worse outcomes in hospitals, especially when the hospital cares for a large number of minorities, according to researchers at Massachusetts General Hospital in Boston.
Both reports, presented at the American Stroke Association (ASA) International Stroke Conference 2007, held February 7–9 in San Francisco, were based on analyses from ASA's Get With the Guidelines (GWTG) stroke database, which includes data on 50,000 stroke patients nationally. The database, which serves as a quality-improvement program for acute stroke treatment and prevention, is co-sponsored by GlaxoSmithKline and Merck/Schering-Plough for the American Heart Association/ASA. GWTG recommends that clinicians encourage patients with diabetes to maintain "intense" control of blood glucose levels to reduce their risk of stroke.
Lee Schwamm, MD, vice chairman of neurology and director of acute stroke services at Massachusetts General Hospital, and researchers analyzed data on >159,000 patients who presented to hospitals for stroke or transient ischemic attack. They looked at the status of various risk factors at the time of admission and assessed whether a patient was diagnosed with diabetes prior to the stroke. They also compared in-hospital treatment of patients who were diagnosed or undiagnosed at the time of stroke with recommended guidelines in the GWTG-Stroke program.
Patients showed high rates of obesity, hypertension, hyperlipidemia, and poor blood glucose control when their stroke occurred, according to researchers. Patients who were unaware of their diabetes fared even worse when it came to controlling the risk factors compared with patients who knew they had diabetes at the time of their stroke. Therefore, the researchers concluded, patients with diabetes who remain undiagnosed when they undergo a stroke may be at increased risk for recurring stroke and cardiovascular disease.
Clearly, more emphasis is needed on diagnosing diabetes early and managing risk factors, says Schwamm.
"Patients who have better controlled diabetes are less likely to have
microvascular complications such as renal failure, retinopathy, and
neuropathy. Tighter control of diabetes might further reduce the risk of
stroke, although we don't have definitive evidence yet," adds Schwamm.
Ethnicity Impacts Stroke Care
In a related study, researchers found that African Americans received less effective and fewer interventions in acute stroke care, but the difference was related to the type of hospital rather than the ethnicity of the patient. Stroke patient data were reviewed from 656 hospitals that participate in the GWTG-Stroke program. Hospitals were categorized based on the number of African Americans treated: 0–2%, 3–10%, 11–25%, and >25%.
Ethnicity played a role in health care delivery at hospitals in which African Americans made up >25% of the stroke patients treated. Available resources and ethnic differences could account for the discrepancy, says Lee Schwamm, MD.
"We found that disparities in care were related more to the hospitals where patients were treated than to race itself," he said.
Footnotes
A new report, "Acute Stroke: Evaluation and Treatment," is available from the Department of Health and Human Services' Agency for Healthcare Research and Quality. The summary can be found at www.ahrq.gov/clinic/epcsums/acstrokesum.htm.
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