Welcome to the WSC 2022 Interactive Program
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*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
HEALTH EQUITY FRAMEWORK: GUIDING TORONTO STROKE NETWORKS’ INITIATIVE PLANNING AND IMPLEMENTATION
Abstract
Background and Aims
According to the World Health Organization, “Health equity is defined as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically”. 1 Health inequities persist globally in healthcare, despite awareness of inequities and actionable strategies. As leaders in integrated regional stroke care, the Toronto Stroke Networks (TSNs) sought to understand the health equity experience of persons with stroke in Toronto, Canada to address inequities in stroke care.
Methods
A human-centered design approach was utilized to conduct primary and secondary research that included: data and literature review, empathy interviews, journey mapping, site visits, and a review of existing TSNs resources. Findings were used to develop insights, provide recommendations and inform the development of a sustainable stroke specific Health Equity Framework.
Results
Twenty stroke system stakeholders and health equity experts, 5 persons with lived experience of stroke and 11 TSNs team members participated in the empathy interviews, journey mapping, and site visits. The Health Equity Framework includes 5 pillars: culture, language, equity-based evaluation, access to resources and support, and linkages and partnerships.
Conclusions
The developed Health Equity Framework will be used to guide future work of the TSNs and could be adapted for application to support system planning, decision-making, and change leadership with other populations. Further efforts are needed to centrally collect and use stroke-specific health-equity data across the continuum. This would allow for the identification of health inequities and the opportunity to develop strategies to address them.
RACIAL DISPARITIES AMONG STROKE CLINICAL TRIALS BETWEEN 1995-2021
Abstract
Background and Aims
Race is a social construct which impacts health outcomes. Race is under-reported in clinical trials making it difficult to identify and address health inequities. In this study, we analyze studies pertaining to stroke with a primary objective of assessing the inclusion of racial data in stroke clinical trials.
Methods
This meta-analysis consisted of stroke clinical trial data from ClinicalTrials.gov. Two researchers extracted data independently. Microsoft Excel was used for data collection and analysis. The search term “stroke” was used to search clinical trials from 1995-2021. The primary outcome is the prevalence of trials with racial data reported. The secondary outcome is the racial and gender diversity among participants.
Results
7004 trials were identified. After excluding non-interventional trials, 468 trials remained of which, 233 studies (49.8%) reported race. The 233 trials with race data totaled 291,876 participants of which 72% were White, 5.05% Black and 19.5% “combined other.” 37.9% were female and 62.0% were male. There were 423,694 participants in 167 trials with pharmacologic intervention, of which 136,847 (32.2%) were female and 286,860 (67.7%) were male. 78 (46.7%) of the 167 trials had race reported resulting in 253,281 (59.8%) participants with race reported. 73.0% of participants were White, 3.76% Black and 19.8% “combined other.”
Conclusions
Of the stroke clinical trials reviewed, 49.8% reported race and 46.7% of studies with pharmacologic intervention reported race. Moreover, women and non-White subjects were significantly underrepresented in stroke clinical trials. The under-representation of women and non-White subjects in these clinical trials merits further study.
COST-EFFECTIVENESS OF THROMBECTOMY ALONE VERSUS ALTEPLASE PROCEEDING THROMBECTOMY IN ACUTE ISCHEMIC STROKE: RESULTS FROM THE DIRECT-MT TRIAL
Abstract
Background and Aims
We assessed the cost-effectiveness of EVT versus combination therapy in DIRECT-MT trial
Methods
We conducted a post hoc within-trial economic analysis of the randomize DIRECT-MT trial based on an intention-to-treat approach. Index stroke cost were collected on individual level; cost after discharge were complemented by published literature and government websites. Utility weights assessed at 90 days using the EuroQol-5-dimension questionnaire were prospectively collected. Long-term modeled cost-effectiveness analysis used a Markov model with 7 health states corresponding to the modified Rankin Scale scores.
Results
During the index hospitalization, the medication cost in EVT-alone group was $487 lower than that in the combination therapy group ($2453, 95% CI [2205,2701] versus $2940, 95% CI [2703,3178], P=0.01), but the overall cost were similar across the groups ($15565, 95% CI [14876,16254] versus $15472 95%CI [14714,16230], P=0.73). Within 90-day of the trial, there were no significant differences in total costs (difference, $-222, 95%CI [-603, 161], P=0.06, from bootstrapping) or utility values (median, 0.84, IQR [0.48, 0.95] versus median, 0.85, IQR [0.26, 1.00]; beta coefficient, 0.00, 95%CI [-0.06, 0.07]) in the comparison of EVT alone versus combination therapy. Over the lifetime horizon, EVT-alone and combination-therapy yielded comparable lifetime QALYs (2.02 QALYs, 95%CI [-0.07, 4.55] versus 1.90 QALYs, 95%CI [-0.09, 4.55] and costs ($26795, 95%CI [15281, 54463] versus $27632, 95%CI [14558, 52251]).
Conclusions
In this economic analysis based on a trial conducted in China, we found EVT alone was not associated with an economic dominance over combination therapy in patients with anterior circulation large vessel occlusion and treated with EVT