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Survival After Stroke Better for Blacks
Date:1/31/2011

By Steven Reinberg
HealthDay Reporter

MONDAY, Jan. 31 (HealthDay News) -- Although blacks face a higher risk of having a stroke, they appear to have better odds of surviving one than whites do, a new study finds.

This finding might seem odd since conventional wisdom says black patients typically fare worse than whites when it comes to medical care in general. However, the same trend has been noticed in other areas such as heart attack and heart failure, hip fractures and gastrointestinal bleeding, the University of Rochester researchers added.

"The question is why that might be the case," said study author Dr. Robert Holloway, a professor of neurology.

To answer that question, the researchers looked into several possibilities, particularly the care patients received. They found that black patients were more likely than whites to have aggressive care, which Holloway believes played a major role in their improved survival.

The more aggressive measures included dialysis, a tracheostomy (a breathing tube) or cardiac resuscitation, Holloway said. Blacks had a higher rate of these interventions than whites, he noted.

"Maybe part of the difference in survival [between blacks and whites] may be the different rate of life-sustaining intervention," Holloway said.

Why black patients have higher rates of these treatments isn't known, he added. But part of it may be the care decisions black patients and their families make compared to the ones white patients and their families make, Holloway said.

However, Dr. Larry B. Goldstein, a professor of neurology and director of the Duke Stroke Center at Duke University Medical Center thinks the reason may be biological.

"Stroke severity is the single most important determinant of outcome," he said. "African Americans more commonly have small vessel-type strokes than non-African Americans, which are generally less severe and have a better prognosis than large-vessel distribution strokes," Goldstein said.

Holloway agreed. "We can't exclude that possibility," he said. "But there is something going on that is more than just small vessel versus large vessel -- there is something more there. My gut tells me [the care they are getting] has to be part of the explanation."

The report is published in the Feb. 1 issue of the Annals of Internal Medicine.

For the study, Holloway's team collected data on 5,319 black patients and 18,340 white patients hospitalized for stroke from January 2005 to December 2006.

During follow-up, 5 percent of the black patients died in the hospital, compared with 7.4 percent of the white patients. After 30 days, 6.1 percent of the black patients died from any cause, compared with 11.4 percent of the white patients, the researchers found.

After one year, 16.5 percent of the black patients had died, compared with 24.4 percent of the white patients, they reported.

In addition, black patients were 22 percent more likely to receive more aggressive care than whites.

Moreover, compared with white patients, black patients were 75 percent less likely to be admitted to a hospice after leaving the hospital, Holloway's group found.

Holloway thinks these findings are important, especially in light of the new paradigm called patient-centered care. How care options are explained and decisions about care are made have become areas that need to be better understood, he said. This includes how patients and their families make these decisions, he added.

"There is a lot of policy now that uses 30-day mortality as a measure of quality," he said. The question is "are there incidences when you have a well-informed patient who decides to forgo life-sustaining interventions -- that has a higher mortality, but it could be excellent quality," Holloway said. "Using 30-day mortality as a measure of quality may not be as simple as it sounds."

More information

For more information on stroke, visit the U.S. National Library of Medicine.

SOURCES: Robert Holloway, M.D., M.P.H., professor, neurology, University of Rochester, Rochester, N.Y.; Larry B. Goldstein, M.D., professor, neurology, and director, Duke Stroke Center, Duke University Medical Center, Durham, N.C.; Feb. 1, 2011, Annals of Internal Medicine


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