Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study.

Autor:	Dhand A; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Department of Neurology (A.D., Z.R.R.-W., V.A.D.), Brigham and Women's Hospital, Boston, MA.; Network Science Institute, Northeastern University, Boston, MA (A.D.)., Reeves MJ; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)., Mu Y; Department of Biostatistics, Channing Laboratory, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., B.A.R.)., Rosner BA; Department of Biostatistics, Channing Laboratory, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., B.A.R.)., Rothfeld-Wehrwein ZR; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Department of Neurology (A.D., Z.R.R.-W., V.A.D.), Brigham and Women's Hospital, Boston, MA., Nieves A; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (A.N.)., Dhongade VA; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Department of Neurology (A.D., Z.R.R.-W., V.A.D.), Brigham and Women's Hospital, Boston, MA., Jarman M; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Department of Otolaryngology-Head and Neck Surgery (M.J., R.W.B.), Brigham and Women's Hospital, Boston, MA., Bergmark RW; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Center for Surgery and Public Health (R.W.B., R.S.S.), Brigham and Women's Hospital, Boston, MA.; Department of Otolaryngology-Head and Neck Surgery (M.J., R.W.B.), Brigham and Women's Hospital, Boston, MA., Semco RS; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Center for Surgery and Public Health (R.W.B., R.S.S.), Brigham and Women's Hospital, Boston, MA., Ader J; Department of Neurology, Columbia University Irving Medical Center, New York, NY (J.A.)., Marshall BDL; Department of Epidemiology, Brown University School of Public Health, Providence, RI (B.D.L.M., W.C.G.)., Goedel WC; Department of Epidemiology, Brown University School of Public Health, Providence, RI (B.D.L.M., W.C.G.)., Fonarow GC; Department of Cardiology (G.C.F.), University of California, Los Angeles David Geffen School of Medicine., Smith EE; Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.)., Saver JL; Department of Neurology (J.L.S.), University of California, Los Angeles David Geffen School of Medicine., Schwamm LH; Harvard Medical School Boston, MA (A.D., Z.R.R.-W., V.A.D., M.J., R.W.B., R.S.S., L.H.S.).; Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.)., Sheth KN; Department of Neurology & Neurosurgery, Yale School of Medicine, New Haven, CT (K.N.S.).; Yale Center for Brain & Mind Health, New Haven, CT (K.N.S.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2024 Jun; Vol. 55 (6), pp. 1507-1516. Date of Electronic Publication: 2024 May 24.
DOI:	10.1161/STROKEAHA.123.045521
Abstrakt:	Background: Delays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability. Methods: We studied patients with ischemic stroke who arrived by emergency medical services in 2015 to 2017 from the American Heart Association Get With The Guidelines-Stroke registry. The primary outcome was time to hospital arrival after stroke (in minutes), beginning at last known well in most cases. Using Geographic Information System mapping, we displayed the geography of delay. We then used Cox proportional hazard models to study the relationship between community-level factors and arrival time (adjusted hazard ratios [aHR] <1.0 indicate delay). The primary exposure was the social vulnerability index (SVI), a metric of social vulnerability for every ZIP Code Tabulation Area ranging from 0.0 to 1.0. Results: Of 750 336 patients, 149 145 met inclusion criteria. The mean age was 73 years, and 51% were female. The median time to hospital arrival was 140 minutes (Q1: 60 minutes, Q3: 458 minutes). The geospatial map revealed that many zones of delay overlapped with socially vulnerable areas (https://harvard-cga.maps.arcgis.com/apps/webappviewer/index.html?id=08f6e885c71b457f83cefc71013bcaa7). Cox models (aHR, 95% CI) confirmed that higher SVI, including quartiles 3 (aHR, 0.96 [95% CI, 0.93-0.98]) and 4 (aHR, 0.93 [95% CI, 0.91-0.95]), was associated with delay. Patients from SVI quartile 4 neighborhoods arrived 15.6 minutes [15-16.2] slower than patients from SVI quartile 1. Specific SVI themes associated with delay were a community's socioeconomic status (aHR, 0.80 [95% CI, 0.74-0.85]) and housing type and transportation (aHR, 0.89 [95% CI, 0.84-0.94]). Conclusions: This map of acute stroke presentation times shows areas with a high incidence of delay. Increased social vulnerability characterizes these areas. Such places should be systematically targeted to improve population-level stroke presentation times. Competing Interests: Disclosures Dr Dhand is Co-Founder and has stock options in ECHAS (Emergency Call for Heart Attack and Stroke). He is also a consultant for Availity and participates in expert witness activities. Dr Bergmark a consultant for Analysis Group and received grant funding from I-Mab Biopharma, and reports grants from Brigham and Women’s Hospital. Dr Fonarow is a consultant for Abbott Pharmaceuticals, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly and Company, Janssen Pharmaceuticals, Medtronic, Merck, Novartis, and Pfizer. Dr Saver is a consultant for Abbott Laboratories, Aeromics, Biogen, Boehringer Ingelheim, BrainQ, BrainGate, CSL Behring, Johnson & Johnson Health Care Systems Inc, Medtronic, MindRhythm, Neuronics Medical, Rapid Medical, Roche, and Stream Medical. He is on the data and safety monitoring board for MIVI Neuroscience. Dr Schwamm is a consultant for Genentech and Medtronic. Dr Sheth is President for Advanced Innovation in Medicine. He has stock options in BrainQ and receives grant support from BARD and Hyperfine. He is a consultant for Astrocyte, Cerevasc, CSL Behring, and Rhaeos. He is on the data and safety monitoring board for Sense. He reports a patent pending for Stroke wearables licensed to Alva Health
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu