Background:
Hispanic Americans (HA) and African Americans (AA) are known to have greater incidence of stroke and may have more severe deficits than non-Hispanic whites (NHW). AA and HA are known to have higher incidences of hypertension compared to NHW. Little has been published on the use of echocardiography to determine racial and ethnic distribution of risk factors Recently published information indicates that while minorities have equal access to rehabilitative services, minorities with stroke have longer hospital stays and poorer functional outcomes compared to NHW, leading to potential increased healthcare needs post-discharge.
Hypothesis:
We hypothesize that HA and AA are more likely than NHW to have evidence of hypertensive pathology on echocardiographic evaluation. We further hypothesize that HA, due to social and cultural differences, are more likely to discharge home and less likely than AA and NHW to utilize skilled nursing facilities (SNF) or long term acute care facilities (LTAC).
Methods:
We conducted a retrospective chart review of patients at a single institution with a diagnosis of TIA, ischemic or hemorrhagic stroke admitted from January 2004 to January 2007 (N=1480). Demographic information, co-morbid conditions, diagnostic test results, and information regarding discharge were collected. We used descriptive statistics to characterize the groups, and association between ethnicity and echocardiogram evaluation and discharge disposition was tested by Chi-square analysis.
Results:
TTE and TEE were used equally across ethnic groups. AA had more evidence of hypertensive pathology on echocardiographic imaging compared to NHW and HA (95% vs. 43% and 40%, respectively, p<.001). Unexpectedly, HA were more likely to have potential embolic sources found on echocardiographic studies compared to NHW or AA (68% vs. 38% and 44% respectively, p<.001). HA were less likely to discharge to SNF or LTAC compared to NHW or AA (2% vs. 7% for both NHW and AA, p<.001). There was no difference in the likelihood of discharge to SNF or LTAC between AA and NHW.
Conclusions:
HA have more embolic sources as a potential cause for stroke compared to either NHW or AA. This may have impact on the diagnostic utilization of TTE and TEE. Hypertensive echochardiographic changes are common in AA, emphasizing the need for primary prevention. HA are more likely to discharge home, rather than to a SNF or LTAC facility. This finding may indicate a need for additional home care services and education regarding home care of stroke patients for this population.
DISCHARGE HOME HEALTH REFERRAL IS ASSOCIATED WITH HIGHER POST-DISCHARGE 30-DAY ALL-CAUSE READMISSION AND ALL-CAUSE MORTALITY AMONG OLDER MEDICARE BENEFICIARIES HOSPITALIZED FOR HEART FAILURE
