Abstract WP332: Recurrent Ischemic Stroke: Patient Characteristics, Hospital Arrival Mode, And Outcomes, Paul Coverdell National Acute Stroke Program 2016-18

Introduction: Better characterizing patients with recurrent ischemic stroke, whether they are more likely to arrive by ambulance, and their outcomes is important to reinforcing prevention practices and identifying disparities. Method: We identified 226,974 admissions with a clinical diagnosis of ischemic stroke, age≥18 years, from 463 participating hospitals in the PCNASP from 2016-2018, 58,505 or 25.8% of which had a recurrent stroke. We compared descriptive and clinical features of those with a first stroke with those having recurrent stroke. Results: A higher proportion of recurrent stroke admissions was found among black (vs. white) patients: 32.2% vs 24.3%). Recurrent stroke patients were more likely to arrive by ambulance (52.8% vs 45.0%), suffer a more severe stroke (mean NIHSS 6.8 vs 5.9) and less likely to receive alteplase (7.9% vs 10.9%) than those with their first stroke. In addition, those with a recurrent stroke were also more likely to have worse outcomes with fewer recurrent stroke patients being discharged home (42.7% vs 51%). Small differences were seen in the proportion of recurrent stroke patients who were able to ambulate with assistance before their stroke but were then unable to ambulate at discharge (2.2% vs 0.9% for first stroke patients). There were no significant differences seen for in-hospital death. Conclusion: Black patients with ischemic strokes had a higher proportion of recurrent events. Recurrent stroke patients were more likely to arrive by ambulance, and suffer a more severe stroke and have worse outcomes. Understanding disparities among those with recurrent stroke may support public health practitioners and health care professionals intervene to prevent or manage recurrent stroke.