Posted on January 31, 2018

Asian-American Ethnicity Associated with Severe Stroke, Worse Outcomes

American Heart Association Meeting Report, January 25, 2018

Asian Americans were more likely to experience a severe ischemic stroke and have worse outcomes than whites, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2018, a world premier meeting dedicated to the science and treatment of cerebrovascular disease for researchers and clinicians.

Little is known about stroke care and trends over time in Asian Americans. This study is the largest analysis of clinical and functional outcomes for Asian-American acute ischemic stroke patients. Researchers reviewed the clinical and functional outcomes of more than 1.77 million ischemic stroke patients (3.6 percent Asian American and 96.4 percent white).

“Asian Americans may have a distinctive pathophysiologic profile of ischemic stroke than whites,” said Sarah Song, M.D., Ph.D., M.P.H., study author and assistant professor of cerebrovascular disease in the Department of Neurology at Rush University Medical Center in Chicago, Illinois. “Regardless, this study highlights the need for more focused research, improved stroke prevention and possibly different treatment strategies for Asian Americans.”

In the large analysis, researchers also found that compared to whites, being Asian-American was associated with:

  • poorer functional recovery;
  • receiving the clot-busting drug tissue plasminogen activator (tPA) less frequently, which can improve the chances of recovering from a stroke; and
  • more serious and bleeding complications with tPA, despite receiving it quickly.

One good point the findings revealed, she said, is that stroke care for both Asian Americans and whites seems to have improved over time. “Looking from 2004 to 2016, our study shows that overall, patients with acute ischemic stroke are recovering more, and they are receiving more IV tPA, with less complications and better post-stroke care. This likely has to do with an overall improvement in stroke quality and highly effective stroke systems of care. However, Asian Americans and whites had nuanced differences over time; for example, only whites had a decrease in trend in stroke severity, while Asian Americans had a greater increase in timely IV tPA administration.”

Researchers used clinical characteristics, treatment patterns and outcomes from acute ischemic stroke admissions for Asian-American and white patients from 2004 through 2016 from 2,171 hospitals participating in Get With The Guidelines-Stroke – the American Heart Association/American Stroke Association in-hospital program that focuses on improving stroke care by promoting consistent adherence to the latest scientific treatment guidelines.

Limited attention has been given to stroke and stroke care in Asian-American minorities, due to barriers in care, education and research. In addition, Song said, “Even among Asian Americans, the various minority populations differ in so many ways. Vietnamese people are not the same as Korean, who are not the same as Japanese or South Asian groups. Aside from differences in language, differences in stroke risk factors, diet and lifestyle, and other cultural factors, make compiling all Asian-American groups into one single group problematic.”

Putting all the groups together makes it difficult to pull out meaning for each group, which she considers a limitation of this study. “But I do think this is a very good first step,” Song said. “This information gives us the urgency and the credibility to do more research in Asian Americans, who have historically been understudied in the stroke and cardiovascular literature.”

Co-authors are Li Liang, Ph.D.; Gregg Fonarow, M.D.; Eric E. Smith, M.D., MPH; Deepak Bhatt, M.D., MPH; Roland Matsouaka, Ph,D.; Ying Xian, M.D., Ph.D.; Lee Schwamm, M.D. and Jeffrey Saver, M.D.  Author disclosures are on the abstract.

The American Heart Association/American Stroke Association’s Get with the Guidelines-Stroke database provided the data for the study.