SC Connecticut News

When it comes to stroke treatment, every minute counts. A new study identifies factors associated with treatment delays — and targets for intervention.

By Mallory Locklear

May 24, 2024

When it comes to responding to a stroke, speed is a crucial factor; the longer it takes for someone experiencing a stroke to get to a hospital, the worse the outcome will be. Yet across the United States, delays in treatment can be significant.

A Yale study uncovers new insights into factors associated with treatment delays and where in the United States patients are more likely to experience slower responses. The findings, published May 24 in the journal Stroke, highlight where interventions should be focused to improve stroke outcomes across the country.

During an acute stroke, a blood clot reaches the brain, blocking blood flow and essential oxygen to brain tissue. The longer it takes to restore blood flow, the more tissue will be damaged, leaving patients with reduced abilities in those functions for which the affected brain region is responsible.

Currently, there are two main treatments used in hospitals for patients experiencing a stroke; both aim to break the blood clot and restore blood flow. One involves medication — a drug called tissue plasminogen activator (tPA) — and the other is a physical approach wherein doctors remove the clot with a tiny tube threaded through a patient’s blood vessels.

“Both are time-dependent,” said Kevin Sheth, professor of neurology and neurosurgery at Yale School of Medicine and senior author of the new study. “The window to use tPA closes four and a half hours after the stroke. Physical removal is more complicated but can be done up to 12 to 16 hours after the stroke begins. But every minute counts, and even within those windows earlier is better.”

To better understand what factors contribute to treatment delays across the country, researchers from Yale collaborated with researchers at Brigham and Women’s Hospital in Cambridge, Massachusetts. They used data collected from the “Get with the Guidelines-Stroke” registry, launched by the American Heart Association in 2003.

Across nearly 150,000 patients who experienced a stroke between January 2015 and March 2017, 54% arrived at a hospital more than two hours after symptom onset. Compared with patients who arrived earlier, those who took longer were more likely older females or Black individuals who had mild strokes—findings that align with previous studies.

The researchers also examined community-level social vulnerability using scores calculated by U.S. Centers for Disease Control and Prevention based on socioeconomic factors among others. Higher scores indicate greater vulnerability.

In this study, they found that patients facing longer delays were more likely living in communities with higher social vulnerability scores. Socioeconomic status along with housing type and transportation availability had strong associations with delay.

The researchers created an interactive map showing how long it took for patients nationwide arriving at hospitals which could help target interventions effectively.

One strategy suggested by researchers involves creating education campaigns: “The most powerful motivator for going to emergency departments is pain,” said Sheth.“But strokes aren’t usually associated with pain... So informing people about signs of strokes could help motivate them seek treatment earlier.”

Although large-scale education campaigns have been conducted previously without making sizable differences; targeting communities identified as having longer delays might prove effective according Sheth adding that more ideas are needed because there hasn't really been effort proposing/testing new interventions despite acute strokes being big problem requiring fast hospital arrival.

 

“For how big problem this treating acute strokes poses getting people hospitals fast enough remains single biggest challenge," he concluded.