Abstract Number ‐ 192: Acute Ischemic Stroke in Patients with Psychiatric Disorders: Disparities in Interventions and Outcomes

Abstract

Introduction Patients with a psychiatric diagnosis have been shown to have higher rates of illness and premature death due to various diseases when compared to the general population [1]. Previous research has shown higher rates of stroke and lower rates of carotid endarterectomy/stenting for those with psychiatric disorders [2]. This study aimed to investigate differences in interventions and outcomes of patients with acute ischemic stroke (AIS) in those with and without psychiatric disorders. Methods We identified patients with AIS in the Nationwide Inpatient Sample (NIS) database using ICD‐9‐CM/ICD‐10‐CM codes, including a sub‐group of AIS patients with a co‐occurring psychiatric diagnosis. Psychiatric diagnosis included major depressive disorder, schizophrenia, bipolar disorder, and generalized anxiety disorder. Baseline demographic characteristics such as age, race, psychiatric disorder status, stroke severity, obesity, hypertension, diabetes, long term anticoagulant use, and COPD were assessed in both groups. Both groups were then evaluated for differences in rates of intervention (IV thrombolytic therapy and endovascular mechanical thrombectomy) as well as in‐hospital mortality and poor functional outcome, which was defined as discharge to long‐term rehabilitation facilities (skilled nursing facilities and hospice), subsequent placement of respiratory or alimentary tubes, or death. Results We identified 1,609,817 patients with acute ischemic stroke, of which 218,549 (13.5%) had a comorbid psychiatric condition. AIS patients with a psychiatric condition were more likely to have risk factors such as obesity, hypertension, tobacco use, and COPD. Patients with a psychiatric condition were less likely to be treated with mechanical thrombectomy (1.18% vs 1.33%, p < 0.01) as compared to those without a psychiatric condition. In the entire cohort, patients with a psychiatric condition had higher rates of poor functional outcome (61.25% vs 57.6%, p < 0.01). AIS patients with a psychiatric condition who were offered mechanical thrombectomy had lower rates of poor functional outcome (74.67% vs 81.04%, p < 0.01) and in‐hospital mortality (11.34% vs 15.45%, p < 0.01) than their non‐psychiatric condition counterparts. This decrease in poor functional outcome and mortality persisted with propensity score matching for baseline characteristics in the entire cohort, regardless of intervention offered. Conclusions To our knowledge, this is the first study to investigate treatments and outcomes of AIS patients with psychiatric conditions. Patients with psychiatric disorders were less likely to be treated with mechanical thrombectomy even when controlling for all baseline risk factors. In both the unadjusted and propensity score analysis, patients with psychiatric disorders who were offered mechanical thrombectomy had lower rates of poor functional outcome, suggesting the need for further investigation into the reasons for the disparities in treatment being offered. Exclusion of patients with psychiatric disorders in clinical trials should be reconsidered to better serve this population.