Social factors influencing hospital arrival time in acute ischemic stroke patients

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p <0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

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Abstract TP292: Discrepancies in Arrival Time for Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.49.suppl_1.tp292 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Scott J Mendelson ◽

Christopher T Richards ◽

Shyam Prabhakaran

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Arrival Time ◽

Stroke Patients

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Abstract TP381: Discrepancies in Arrival Time for Acute Ischemic Stroke Patients: An Opportunity for Improvement

Stroke ◽

10.1161/str.50.suppl_1.tp381 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Scott J Mendelson ◽

Christopher T Richards ◽

Shyam Prabhakaran

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Arrival Time ◽

Stroke Patients

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Factors influencing pre-hospital delay among acute ischemic stroke patients in the midlands of China

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.01.047 ◽

2014 ◽

Vol 172 (2) ◽

pp. 533-534 ◽

Cited By ~ 7

Author(s):

Huajie Yang ◽

Juan Zhang ◽

Jun Xie ◽

Chen Yang ◽

Xiaoxin Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Factors Influencing

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Abstract TP495: Symptom Onset To Arrival Time And Outcomes Among Acute Ischemic Stroke Patients, Paul Coverdell National Acute Stroke Program (PCNASP) 2016-2018

Stroke ◽

10.1161/str.51.suppl_1.tp495 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amena Y Abbas ◽

Erika C Odom ◽

Sallyann Coleman King ◽

Xin Tong ◽

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Symptom Onset ◽

Arrival Time ◽

Treatment Guidelines ◽

Stroke Severity ◽

Stroke Patients ◽

Early Management ◽

Arrival Times

Introduction: Early use of intravenous (IV) alteplase among those with Acute Ischemic Stroke (AIS) has been associated with better outcomes. However, many patients are ineligible for treatment due to late arrival or contraindications. We used PCNASP data to examine the descriptive characteristics and clinical outcomes associated with arrival time. Methods: A total of 233,794 patients were identified with an AIS in PCNASP data from 2016-2018. A total of 131,195 (56%) patients had documented last known well time (LKW). Symptom onset to arrival times (OAT) were categorized into the following using LKW and ED arrival times: 0-2, >2 and ≤3, >3 and ≤4.5, >4.5 hours. We assessed associations between OAT and two outcomes - discharge to home and independent ambulation at discharge using generalized estimating equations (GEE) modeling. Results: Patients with documented LKW time had the following OAT: 39,694 (30.3%) 0-2 hours, 11,573 (8.8%) >2 and ≤3 hours, 13,582 (10.3%) >3 and ≤4.5 hours, and 66,346 (50.6%) >4.5 hours. Overall, 51% were male, 75% were Whites, and 51% of patients arrived by ambulance. Only 17% of patients received IV alteplase. After adjusting for age, sex, race, arrival by ambulance, stroke severity score, and IV alteplase use, compared to those arriving >4.5 hours of symptom onset, patients arriving ≤4.5 hours were more likely to be discharged to home (0-2, 1.85 [1.79, 1.92]; >2 and ≤3, 1.38 [1.32, 1.45]; >3 and ≤4.5, 1.13 [1.08, 1.18]; referent >4.5), and independently ambulate at discharge (0-2, 1.89 [1.82, 1.96]; >2 and ≤3, 1.41 [1.34, 1.48]; >3 and ≤4.5, 1.15 [1.10, 1.21], referent >4.5) (Table). Conclusion: In this study, shorter OAT were associated with better outcomes for AIS patients. Although significant progress has been made in the early management and treatment of stroke, continued efforts are needed to emphasize the significance of early hospital arrival and promote implementation of treatment guidelines to improve clinical outcomes for all stroke patients.

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