Bridging the Distance for Ischaemic Stroke Treatment in Regional Australia: A Retrospective Cohort Study

One comprehensive stroke centre (CSC), in North Queensland, Australia, supports almost 700 000 people across 750 000 km². Access to urgent ischaemic stroke treatment is challenging for remote and regional residents, who are more likely to carry stroke risk factors and have a 17% higher stroke incidence than those in major cities.

To review and report on patient demographics, stroke characteristics, interventions, and outcomes of ischaemic stroke in this regional population.

Retrospective review of admissions to a North Queensland CSC (March 2022-September 2023) with acute ischaemic stroke (ICD-10-AM: 163).

Among 305 patients, the median age was 72 years, 57% were male, and 10.5% identified as First Nations. Common stroke risk factors included hypertension (83%), smoking background (58%) and hypercholesterolaemia (57%). Stroke aetiology was unknown in 42%, followed by cardioembolic (31%). Median onset-to-emergency department time was 90 min, and to the CSC was 343 min. Thrombolysis was administered to 6% at the referring facility, and 7% on arrival to the CSC (median door-to-needle time, 73 min). Endovascular clot retrieval occurred in 11.7% of the primary presenters, with an overall successful recanalisation rate of 89%. The 6-month mortality rate was 22%.

High rates of modifiable risk factors require improved community management. Delayed presentation highlights potential gaps in stroke awareness and access to healthcare in this region. Reaching timely reperfusion targets should become a priority, which requires support from multiple stakeholders. The high proportion of unknown aetiologies may reflect incomplete stroke work-up, documentation, or loss to follow-up. Targeted stroke education for regional and remote communities and healthcare providers is recommended.