Stroke among Australian aboriginals in Perth, WA, 1988-1992

A prospective analysis of stroke recognition, stroke risk factors, thrombolysis rates and outcomes in Indigenous Australians from a large rural referral hospital

BACKGROUND

Cardiovascular disease is the most common cause of death and disability in Indigenous communities but limited prospective data exists about stroke.

AIM

To estimate the difference in stroke recognition, risk factors, treatment rates and outcomes between Indigenous and non-Indigenous peoples admitted to the Wagga Wagga Rural Referral Hospital (WWRRH) over a 5-year period with a suspected acute stroke.

METHODS

All suspected strokes presenting to the 33 peripheral hospitals within the Murrumbidgee local health district (MLHD) were transferred to the WWRRH and prospectively assessed over a 5-year period from 01/01/2012 to 31/12/2017. Actions at stroke onset, risks factors, stroke type, treatment and outcomes were analysed.

RESULTS

1843 patients were included. Of these, 45 patients (2.5%) were Indigenous. Only 26.6% of Indigenous and 34% of non-Indigenous patients knew of the fast acronym. Indigenous patients were younger (mean age 62.0 years versus 74.4 years) and more likely to have diabetes (RD 22.3% [95% CI: 3%,41.7%]), dyslipidaemia (RD 19.4% [95% CI: 21.%, 36.7%]), and be ever smokers (RD 24.9% [95% CI: 9.5%,40.3%]). Stroke types were similar except lacunar infarcts were more common (19.2% versus 8.4%). Treatment rates and outcomes were similar between the two groups.

CONCLUSIONS

Indigenous Australians with stroke are a decade younger and have a higher prevalence of important, modifiable stroke risk factors. Delayed presentation to hospital is more common, due in part to stroke symptoms being under recognized. When admitted to a specialized stroke unit, treatment rates and outcomes are comparable. This article is protected by copyright. All rights reserved.

Management of stroke in the Australian Indigenous population: from hospitals to communities

BACKGROUND

Ischaemic strokes lead to significant morbidity and mortality within the Australian Indigenous population, with known variances in the management of strokes between indigenous and non-indigenous populations.

AIMS

To compare investigations and management of indigenous and non-indigenous patients presenting to a New South Wales rural referral hospital with an ischaemic stroke to the national stroke standards across inpatient and outpatient settings.

METHODS

Historical cohort study of 43 indigenous and 167 non-indigenous patients admitted to Tamworth Rural Referral Hospital with an ischaemic cerebrovascular accident.

RESULTS

Indigenous patients were significantly less likely to have investigations completed, including carotid imaging (93.8% vs 100%, P = 0.012) and echocardiography (73.3% vs 97.7%, P = 0.004). Discharge follow up was significantly lower for the indigenous population (74.4% vs 87.4%, P = 0.034). Indigenous stroke patients were 15.8 years younger than non-indigenous subjects (56.8 vs 72.6 years old; P < 0.001). Indigenous patients were more likely to have stroke risk factors, including smoking (51.2% vs 15.0%; P < 0.001), diabetes mellitus (37.2% vs 16.8%, P = 0.003) and past history of cerebrovascular accident or transient ischaemic attack (50.2% vs 31.1%, P = 0.032).

CONCLUSIONS

The investigation and post-discharge care of indigenous ischaemic stroke patients is inferior to non-indigenous patients. Indigenous patients within rural NSW have a higher prevalence of preventable disease, including those that confer a higher stroke risk. Further research is needed to investigate the cause of these discrepancies and to improving indigenous stroke care between hospitals and primary care providers.

Hospital management and outcomes of stroke in Indigenous Australians: evidence from the 2009 Acute Care National Stroke Audit

BACKGROUND

Indigenous Australians have greater stroke mortality rates than non-Indigenous people (97% Indigenous Australians are aged <65 years). Quality of care in hospital is an important factor for avoiding death and disability. No national review of acute stroke care for Indigenous Australians is available.

AIMS

We aimed to compare adherence with clinical processes and outcomes among Indigenous and non-Indigenous patients with acute stroke admitted to hospital.

METHODS

Hospitals participating in the National Stroke Audit of acute services in 2009 that provided data for at least one Indigenous patient were included (n = 33, 37%). Differences in death/dependency (modified Rankin Score 3-6) at discharge were determined using two-level multivariate analysis adjusting for hospital site and patient variables. A matched subgroup analysis in those aged 18 to 64 years was also undertaken.

RESULTS

Among 1162 eligible patients (60% male; 18-64 years n = 305), 7% were Indigenous (18-64 years: 18%). Indigenous patients had a greater prevalence of stroke risk factors, e.g. diabetes, more had intracerebral hemorrhages (25% vs. 16% non-Indigenous, P = 0.05), and were less likely be treated in a stroke unit and receive timely allied health assessments than non-Indigenous patients. Indigenous patients aged 18-64 years had a threefold odds of dying or being dependent at discharge (Adjusted odds ratio = 3.09, 95% confidence interval = 1.07-8.95).

CONCLUSIONS

Australian Indigenous patients with stroke received a reduced quality of care in hospitals and experienced worse outcomes than non-Indigenous patients. Indigenous patients require the provision of evidence-based care to increase their opportunities for optimal health outcomes following stroke. Further research to explain the differences is needed.