Release Date : January 17 2024
Stroke: Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control (2023)
About the Guideline
- The guideline panel consisted of nine experts representing nine organizations and councils on behalf of the American Heart Association (AHA) Stroke Council.
- The guideline provides strategies to reduce inequities in five areas across the continuum of stroke care: prehospital; acute care delivery; access to rehabilitation, recovery, and community reintegration; transitions in care; and risk factor control after stroke.
- The guideline focuses on summarizing evidence for interventions to address the inequities across the continuum of stroke care.
- The paucity of underrepresented populations in clinical stroke trials reduces the generalizability of the guidelines to disenfranchised groups.
Key Clinical Considerations
Become familiar with the strategies and best-practice statements provided in this guideline, especially if you work in an acute care setting.
Prehospital
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- Increase awareness of stroke symptoms and the use of emergency medical services by providing education in settings such as churches, hospitals, beauty shops, schools, and clinics.
- Increase access to the use of mobile stroke units, particularly in areas with high population density.
- Decrease the time from stroke symptom onset to emergency department arrival through educational opportunities that focus on scalable individual behavioral interventions.
Acute Care Delivery
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Access to Thrombolytics and Endovascular Treatment
- Institutions should seek stroke center certification and quality improvement programs such as the AHA Get with the Guidelines-Stroke and Joint Commission stroke center regionalized certification.
- Community leaders should seek governmental and culturally tailored community education opportunities to educate the public on stroke symptoms and on ways to seek care.
Telehealth
- Geographic inequities of acute stroke care may be decreased by the provision of telehealth/telemedicine, but further research is needed to determine specific interventions for specific areas and populations to reduce ethnic and racial inequities.
Artificial Intelligence and Machine Learning in Clinical Decision-Making
- Diverse populations should be used to determine artificial intelligence algorithms to be used in diagnosing and planning interventions for ethnic groups experiencing strokes; this could prevent the exacerbation of ethnic and racial inequities.
Diagnostic Evaluation and Initiation of Secondary Stroke Prevention during the Acute Hospital Stay
- Initiate programs to support statin use, counseling for smoking cessation, the provision of antithrombotic therapy upon discharge, in-hospital antithrombotic therapy, deep venous thrombosis prophylaxis, and anticoagulation therapy for atrial fibrillation to prevent recurrent stroke.
- Participate in acute stroke quality improvement programs and stroke center certification.
Rehabilitation, Recovery, and Community Reintegration
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- Develop patient-focused virtual rehabilitation tools with weekly preset exercise goals that are culturally tailored and in multiple languages.
- Seek reimbursement avenues for telerehabilitation, including access to high-speed internet, smart devices, and technology support.
- Provide group exercises that are stroke-specific and that enable social support.
- Conduct educational sessions on medication adherence, physical activity, diet, and self- management skills.
Transitions in Care
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- Strategies to prevent rehospitalization and improve outcomes for stroke patients include determining specific interventions for each organization/facility. These interventions can be supported by collecting data on the following:
- Self-management endpoints (blood pressure self-monitoring, diet, medication adherence)
- Health literacy level
- Access to stroke care
- Readmission rate related to stroke
- Patient-reported outcome measures
- Medical care follow-up rate
- Utilization of rehabilitation interventions
Risk Factor Control after Stroke
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- Use staff or community health workers who are from the same cultural background as the patient population.
- Provide patients with translated educational resources.
- Incorporate cultural training for all staff.
- Utilize individually skill-based educational interventions that are specific for the patient's culture.
- Provide health coaches to facilitate the patient's integration into the community; promote self- management and awareness of risk factors.
- Promote self-efficacy to improve control of risk factors.
- Utilize workshops for patients to enhance self-management of chronic diseases.
- Utilize community health care workers to conduct home visits and provide chronic disease management in addition to individual visits and self-management tools.
- Promote the use of a polypill to reduce cardiovascular inequities.
- Teach patients to regulate dietary intake of salt and sugar.
- Initiate environmental level programs that address access to nutritious affordable food.
- Address neighborhood-level safety and promote physical activity.
Reference
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Towfighi, A., Boden-Albala, B., Cruz-Flores, S., El Husseini, N., Odonkor, C. A., Ovbiagele, B., Sacco, R. L., Skolarus, L. E., Thrift, A. G., & American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; and Council on Peripheral Vascular Disease (2023). Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart
Association.
Stroke,
54(7), e371–e388.
https://doi.org/10.1161/STR.0000000000000437