20 Feb Women and Minorities Have Worse Outcomes After Stroke
MedicalResearch.com Interview with:
Cheryl Bushnell, MD, MHS
Professor of Neurology
Director, Wake Forest Baptist Stroke Center
Wake Forest Baptist Health
Medical Center Boulevard
Winston Salem, NC 27157
Medical Research: What is the background for this study? What are the main findings?
Dr. Bushnell: The catalyst for the study was to see if comorbidities and the management of them might influence functional status. But, we pre-specified gender and race because we knew these could be important predictors of outcome. As it turns out, the results of our analysis did, in fact, show that gender and race were the most significant predictors of poor functional outcome.
Medical Research: What should clinicians and patients take away from your report?
Dr. Bushnell: The take-home message is that women and minorities have poorer functional outcome after stroke, but the reasons for this outcome need to be further explored. Our model showed that we only explained 31% of the variance in SIS-16 with gender, race/ethnicity, and stroke severity, so unmeasured factors are extremely important. We could speculate from this dataset and other published data that women may be more likely to have functional deficits prior to stroke, be unmarried/widowed, live alone, or institutionalized after stroke. Non-white stroke survivors may have poorer access to care, have multiple strokes, and more comorbidities.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Bushnell: We recommend that acute stroke treatment and rehabilitation trials pay special attention to the subgroups of race and gender since this could have major impact on the ability to detect efficacy and effectiveness of an intervention.
Medical Research: Is there anything else you would like to add?
Dr. Bushnell: We will continue to collect these important functional outcomes and have a process for doing so among all stroke survivors discharged home at our hospital. We will be closely evaluating the services that are recommended after discharge and whether patients were able to obtain these services. As we move toward value-based care, these outcomes will become the focal point for our post-acute care processes. Knowing which patients might have worse functional outcomes is an important step.
Bushnell C, Prvu-Bettger J, D’Agostino R, et al. Abstract 108. Women and Minorities have Lower Patient-reported Functional Status 3 Months Post-stroke. Presented at: International Stroke Conference; Feb. 16-19, 2016; Los Angeles
Dr. Cheryl Bushnell (2016). Women and Minorities Have Worse Outcomes After Stroke