Patient-related features associated with a delay in seeking care after stroke

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Timely hospital arrival after stroke onset is critical for effective treatment.
• Patient alert behavior significantly impacts pre-hospital delay.
• Identifying factors associated with delayed stroke alert is essential for targeted interventions.

Purpose of the Study:

• To identify clinical and sociodemographic factors linked to delayed stroke alert.
• To characterize individuals who delay seeking medical attention for stroke.
• To inform public health strategies in Catalonia, Spain.

Main Methods:

• Utilized data from the Stroke Code (SC) registry in Catalan hospitals.
• Included patients with and without SC activation (SCA/SCNA).
• Employed multivariate logistic regression and sample weighting to analyze predictors of delayed alert (beyond 6 hours).
• Conducted structured interviews with SCNA patients to explore beliefs and attitudes.

Main Results:

• 37.2% of patients experienced a delayed alert (>6 hours).
• Latecomers were more likely to be diabetic, illiterate, from lower socioeconomic classes, and live alone.
• Lower rates of atrial fibrillation and emergency medical service (EMS)/112 utilization were observed in mild/moderate stroke latecomers.
• Lack of awareness of stroke's vascular nature and perception of stroke as reversible/irrelevant independently predicted longer delays.

Conclusions:

• Delayed stroke alert has multifactorial origins, including pre-stroke health, socioeconomic status, stroke characteristics, and patient beliefs.
• Educational campaigns should address these diverse factors to reduce pre-hospital delay.
• Improving patient awareness and attitudes towards stroke is crucial for timely intervention.