Objective:
To describe the clinical features of stroke patients from rural and urban areas and to identify possible associations with clinical outcomes.
Introduction:
There is little information in Latin America about risk factors, treatments, and outcomes in stroke patients from rural areas and urban people. The rural population faces multiple healthcare access barriers that might influence stroke outcomes. This paper describes and analyzes clinical features in stroke patients according to their location.
Methods:
Prospective cohort study of Colombian stroke patients using demographic and clinical data collected between 2018 and 2020 in a high complexity hospital from southwestern Colombia, as part of a pilot stroke network consisting of rural primary centers and a mothership center. Mode of transport to the stroke center, timing, clinical characteristics, interventions, and modified Rankin scale (mRS) at discharge and 3 months were assessed.
Results:
We included 579 stroke patients (66.14% ischemic), with a median age of 70 years (60-81). Urban subjects showed higher prevalence of dyslipidemia (p=0.009), previous hemorrhagic stroke (p=0.036), and TIA (p=0.002). Approximately 35% of cases were initially evaluated at a rural primary care center. These subjects exhibited a higher NIHSS scores (10 IQR 5-19 vs. 5 IQR 2-13; p=0.000) with a longer window (p<0.001) and were mainly transferred by ambulance (89.80%, p=0.000). Due to the severity, door-to-imaging time was shorter (p=0.001). Rural patients receive thrombolysis in 27.36% and underwent thrombectomy in 14.43%. Higher mRs at discharge (3 IQR 2-5 vs. 2 IQR 1-4; p=0.000) and three-months follow-up (3 IQR 1-6 vs. 1 IQR 0-4; p<0.001) were observed.
Conclusions:
Rural patients from southwestern Colombia were more likely to present with severe strokes even though they had lower rates of cardiovascular risk factors. They arrived later to the stroke center, but the final diagnosis was reached faster. Nonetheless, disability was higher at discharge and 3-months follow-up.
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