Abstract 306: Influence of healthcare access on rate of follow‐up after mechanical thrombectomy for large vessel occlusion in a unique mountain west population
Authors: Bounajem M. T. , Aubrey J. , Brown J. , Scoville J. , Rennert R. C. , Budohoski K. , Kilburg C. J. , Feler J. , Jayaraman M. , Grandhi R. 
Published: January 2025

Introduction

Stroke remains to be a significant cause of morbidity and mortality in the US, with an estimated 800,000 strokes occurring yearly. It is well understood that thorough follow‐up care and rehabilitation has a significant impact on long‐term outcomes after experiencing a stroke, and especially after undergoing mechanical thrombectomy for a large vessel occlusion (LVO). Mountain west populations experience unique issues in terms of health care access and ability to maintain follow‐up post‐hospitalization given the large distances to stroke/rehabilitation centers/primary care physicians, financial limitations, geographic/climatological barriers. There exist several national and local stratification systems to describe healthcare access, as well as social, financial, and demographic factors at the community level, such as the Utah Healthy Places Index (HPI), Area Deprivation Index (ADI), and Health Professional Shortage Areas (HPSA). These scoring systems are can be used to guide policy and intervention at the level of local and state government, as well as directly through healthcare systems. We therefore sought to examine the influence of HPI, ADI, and HPSA on successful follow‐up after mechanical thrombectomy for LVO.

Materials/Methods

Patients undergoing mechanical thrombectomy for LVO at a single institution between 2016 and 2024 were retrospectively identified. Residency based on patients’ home address was identified, and non‐residents were excluded from analysis. Data collected consisted of demographics, comorbidities, clinical presentation, stroke severity, baseline modified Rankin Score (mRS), mRS on arrival, HPI percentile, ADI percentile, HPSA score, frailty score, thrombolysis score, mRS on discharge, and follow‐up duration and mRS. Of note, while a higher HPI percentile indicates better overall health, a higher ADI or HPSA score indicates lower healthcare access. Multivariable logistic regression was conducted to evaluate the odds of follow‐up relative to HPI/ADI/HPSA scores. Imputation in the form of multiple imputed chained equations was used to address any variables missing >5% of datapoints.

Results

After exclusion of non‐resident patients, 330 patients (184 males, 146 females) were included in analysis. Fifty‐five percent of the patients were male (184) and the remaining 45% were female (146). Average age at presentation was 64 ± 16.5 years old, with a mean HPI percentile score of 48.8 ± 30.2, a mean ADI percentile score of 5.36 ± 2.90, and a median HPSA of 8.70. HPI and ADI scores were not correlated with rate of follow up, however, rate of follow‐up decreased as HPSA score increased (OR 0.24, 95% CI 0.11 ‐ 0.36, p<0.001) and as frailty score increased (OR 0.97, 95% CI 0.96 ‐ 0.99, p<0.001)

Conclusion

Although no correlation was identified between HPI/ADI and follow‐up, HPSA score did appear to significantly impact rate of follow‐up for patients undergoing mechanical thrombectomy for LVO. Increased frailty score was also associated with lower rates of follow‐up, although with a smaller effect size compared to HPSA score. Further investigation is warranted to identify the discerning factors within the HPSA score that contribute to its significant association with follow‐up in comparison to HPI/ADI scores.