Name: Evaluating for racial disparities in intravenous fibrinolytic door-to-needle times at a comprehensive stroke center
Start: 2025-04-24T14:50:00-0400
End: 2025-04-24T15:05:00-0400

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Thursday April 24, 2025 2:50pm - 3:05pm EDT

Athena I

Title: Evaluating for racial disparities in intravenous fibrinolytic door-to-needle times at a comprehensive stroke center

Authors: Morgan Daniel, Ashly Lamosek, Olivia Morgan, Katleen Chester

Objective: The purpose of this study was to identify the effect of racial disparities on fibrinolytic door-to-needle (DTN) times.

Self Assessment Question: What factor contributed to the initial racial disparity observed in DTN times for fibrinolytic administration in acute ischemic stroke treatment?

Background: The phrase “time is brain” is a staple in the world of acute ischemic stroke (AIS) as it reflects on the importance of efficient and timely care for patients to preserve neurons and limit the degree of ischemia. In the stroke setting, barriers and negative outcomes are more prevalent in black patients than white patients. Data has shown that non-white patients experiencing signs and symptoms of AIS were less likely to be treated with fibrinolytics, likely due to delay in presentation and not meeting eligibility criteria for administration. Despite this information, there is limited evidence on the relationship between race and fibrinolytic DTN times as most of the literature is focused mainly on the tele-stroke setting or outcomes in mechanical thrombectomies. The patient population that will be evaluated is unique compared to other literature as these patients are presenting to a safety net comprehensive stroke center located in the heart of what is known as the country's stroke belt.

Methods: This was a single-center, retrospective chart review evaluating patients presenting directly to the Grady Memorial Hospital Emergency Care Center receiving intravenous fibrinolytics (alteplase and tenecteplase) for AIS from January 2018 to May 2024. Patients who received intravenous fibrinolytics via the Mobile Stroke Unit or after hospital admission, were excluded from this study. Data was obtained from the Institutional Stroke Committee fibrinolytic data reports, which are updated monthly. The primary outcome was mean DTN time, between whites versus non-white patients. Secondary outcomes included the percentage of patients who met within 30-, 45-, and 60-minute DTN time goals, means of arrival, presentation time to the Emergency Department (00:01 – 08:00, 08:01 – 16:00, 16:01 – 00:00), and time from last known well to fibrinolytic administration, between white versus non-white patients.

Results: A total of 893 patients treated with intravenous fibrinolytics were analyzed, including 652 non-white and 241 white patients. Non-white patients were significantly younger (median age 63 years [IQR 54–74] vs. 70 years [IQR 61–80], p = 0.025), with no significant difference in sex distribution (56.2% vs. 60.9%, p = 0.056). Median DTN times were longer for non-white patients (45 vs. 41 minutes, p = 0.014). Non-white patients more often required pre-treatment interventions for blood pressure or glucose control (21% vs. 12%, p = 0.003). When accounting for these interventions, DTN times were similar between groups (59 vs. 55 minutes, p = 0.147). A greater proportion of white patients met DTN time goals at 30, 45, and 60 minutes, though differences were not statistically significant (p = 0.139, p = 0.052, p = 0.108, respectively). Arrival methods and presentation times varied significantly. Non-white patients were more likely to arrive by EMS (85.5% vs. 71.8%, p < 0.001) and less likely by air transport (3.7% vs. 24.9%, p < 0.001). They also presented more frequently between 00:01–08:00 (14.6% vs. 8.7%, p = 0.021). Time from last known well to fibrinolytic administration did not differ significantly between groups (140 vs. 144 minutes, p = 0.160).

Conclusion: Racial disparities in fibrinolytic DTN times were initially observed, but these differences were eliminated after accounting for the higher rates of pre-treatment blood pressure and glucose management in non-white patients. This highlights the need for public health initiatives that address disparities in hypertension and diabetes incidence and management in non-white communities. Further research is essential to promote equitable acute stroke care.

Moderators

Elly Glazier

PGY2 Health System Pharmacy Administration and Leadership Resident, Vanderbilt University Medical Center

Elly Glazier, Pharm.D., MMHC, (she/her) is a PGY2 Health-System Pharmacy Administration and Leadership resident at Vanderbilt University Medical Center in Nashville, TN. She is a recent graduate of the University of Missouri-Kansas City School of Pharmacy and completed her pre-pharmacy... Read More →

Presenters

Morgan Daniel

PGY-2 Neurology Pharmacy Resident, Grady Health System

Morgan Daniel, PharmD, is the PGY-2 Neurology Pharmacy Resident at Grady Health System. She earned a Bachelor of Science in Chemistry at the University of North Georgia and received her Doctor of Pharmacy from Mercer University College of Pharmacy. She completed her PGY-1 residency... Read More →

Evaluators