Outcomes of Homeless Ischemic Stroke Patients Receiving Intravenous Thrombolysis in the United States

Autor: Ganesh Asaithambi, Emily H. Marino, Bridget M. Ho, Megan Tipps
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Databases
Factual
medicine.medical_treatment
Population
Psychological intervention
Permanent disability
Risk Assessment
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Risk Factors
Humans
Medicine
Thrombolytic Therapy
Hospital Mortality
Infusions
Intravenous
education
Stroke
Aged
Ischemic Stroke
Retrospective Studies
Medical attention
Aged
80 and over
Inpatients
education.field_of_study
business.industry
Rehabilitation
Thrombolysis
Middle Aged
medicine.disease
United States
Functional Status
Treatment Outcome
Increased risk
Ill-Housed Persons
Emergency medicine
Ischemic stroke
Female
Surgery
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Intracranial Hemorrhages
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 30:105862
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105862
Popis: Background Morbidity and mortality among homeless people with cardiovascular diseases and stroke in the United States is high. Adverse outcomes within the homeless population may be the result of seeking care too late to receive time-sensitive interventions. We sought to investigate the impact of homelessness on ischemic stroke patients who received intravenous thrombolysis (IVT). Methods We determined rates of post-thrombolytic intracranial hemorrhage (ICH), in-hospital death, and development of moderate to severe disability among homeless ischemic stroke patients treated with IVT. Patients were identified using the Nationwide (National) Inpatient Sample between 2002 and 2017. We compared rates of the various outcomes to non-homeless ischemic stroke patients treated with IVT. Results There were 514 homeless (mean age 54.7 ± 10.2 years, 20.4% women) and 364,408 non-homeless (mean age 68.6 ± 14.7 years, 49.7% women) ischemic stroke patients who received IVT. There was no difference in post-thrombolytic ICH rates between the two groups (6.6% homeless versus 8.8% non-homeless, p = 0.09). Homeless patients were more frequently discharged to self-care (p = 0.003). Homeless patients were less likely than non-homeless patients to suffer in-hospital death (AOR 0.499 [95% CI 0.30–0.84], p = 0.009) and moderate to severe disability (AOR 0.423 [95% CI 0.29 - 0.62], p Conclusion Homeless ischemic stroke patients who receive IVT are not at an increased risk of developing post-thrombolytic ICH or in-hospital death. Efforts are needed to encourage this unique population to seek medical attention as soon as possible for time-sensitive interventions that may decrease the risk of permanent disability or death associated with ischemic stroke.
Databáze: OpenAIRE
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