Cardiology consult, poststroke monitoring less common among women vs. men
Key takeaways:
- Women received fewer cardiology referrals and less cardiac monitoring after stroke hospitalization vs. men.
- Mean hospital stay was shorter for women.
- These data may inform new protocols to improve stroke care.
Fewer women received cardiology referrals during index hospitalization and poststroke cardiac monitoring compared with men, and women had shorter average hospital stays, a speaker reported.
Additional results from phase 1 of the ongoing, retrospective, multicenter DiVERT Stroke study designed to improve cardiac care after stroke were presented at the International Stroke Conference.
New findings from the DiVERT study
“DiVERT is a two-phase study. We originally designed it to see how a streamlined organized process would improve, if it even improved at all, some of our most important stroke metrics,” David Z. Rose, MD, professor of vascular neurology at University of South Florida Morsani College of Medicine at Tampa General Hospital, told Healio. “I’m sure there are things we are not so good at in terms of stroke care for neurocardiology, but we didn’t know what they were. That was the point of phase 1, to do a baseline and see how good we were with, for example, cardiac monitoring after three different types of stroke: cryptogenic stroke, large vessel stroke and small vessel stroke.”
Phase 1 of the DiVERT study included attainment of baseline demographics and 6 months of data after discharge for index stroke at five comprehensive stroke centers in the U.S.
Rose said phase 2 of the study is designed to evaluate whether a uniform, streamlined approach could improve not only cardiac monitoring, but cardiology specialty involvement in poststroke care. The results of phase 2 are not yet ready for publication.
Overall, 2,699 patients were included in phase 1, of which 70.9% had an index hospitalization for cryptogenic stroke and nearly half were women (48.8%).
The mean age of women included in the analysis was higher compared with men (68.3 years vs. 65.7 years; P < .001).
Sex differences in poststroke cardiac care
Rose and colleagues reported that compared with men, fewer women received cardiology referrals during index hospitalization (12.8% vs. 15.5%; P = .043); women had shorter average hospital stays (6.8 days vs. 7.7 days; P = .025); and fewer women received poststroke cardiac monitoring (19.9% vs. 23%; P = .048).
“We don’t know why women had differences in care,” Rose told Healio. “We like to say in medicine, ‘it’s multifactorial.’ There’s not just one overarching thing that we could say is why women get different care than men for this specific stroke question.
“The length of stay in the hospital for these stroke subtypes was also much lower for women than for men,” Rose said. “Why is that? Do women want to go home sooner? All things being equal, do they prefer not to get a more thorough workup? Do they have other obligations to take care of at home? These are just hypotheses, and so further research is needed to figure out why this is true, but at least this provides a baseline.”
The researchers observed no significant difference in type of cardiac monitoring, whether external or internal, between men and women who received cardiac monitoring.
The rate of atrial fibrillation detection was higher among patients who received cardiac monitoring compared with those who did not, regardless of sex (7.4% vs. 3.9% for women; P = .015; 8% vs. 3.5% for men; P < .001).
“The ultimate goal is to achieve some sort of uniformity and standardization with respect to cardiac monitoring after these three stroke subtypes. And also make sure that across the board, regardless of gender, age, race, ethnicity or socioeconomic status, everybody gets the same level of care,” Rose told Healio. “Whether they want it or not, that may be a factor. Whether they receive it or not, is ultimately what we found in phase 1, and what hospital they go to is a lot of times not in their choice.”
Rose stated that data from phase 2 of DiVERT will “hopefully be available in the next few months.”
For more information:
David Z. Rose, MD, can be reached at 12901 Bruce B. Downs Blvd., MDC 55, Tampa, FL 33612.
Reference:
- DiVERT Stroke study uncovers sex-based disparities in post-stroke cardiac care. https://news.medtronic.com/DiVERT-Stroke-study-uncovers-sex-based-disparities-in-post-stroke-cardiac-care. Published Feb. 6, 2025. Accessed Feb. 10, 2025.
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Rose DZ, et al. Health services, quality improvement, and patient-centered outcomes posters II. Presented at: International Stroke Conference; Feb. 5-7, 2025; Los Angeles (hybrid meeting).