Acute treatment of ischemic stroke in 19 Sámi language administrative municipalities in the rural inland of Northern Sweden.

Abstract

Objects: The effective treatment of acute stroke requires a series of events, including the recognition of stroke symptoms, following known action plans, and the rapid transfer to a hospital with sufficient medical competence. This is challenging in rural areas with long distances between hospitals with emergency departments. We studied the availability and effectiveness of acute stroke treatment in the most rural parts of northern Sweden. Some of the population in the study area belong to the Sámi, Sweden's indigenous people. Our aim was to study the yearly incidence of ischemic stroke, time window from start of symptoms to arrival at first hospital, and rate of revascularization treatment in the study population and compare to the rest of Sweden.

Methods: Statistics Sweden defined the study group which was 142,127 individuals registered as living in the study area sometimes during 2019-2021. We used data from the National Board of Health and Welfare (NBHWF) regarding incidence and from the Swedish Stroke Register (Riksstroke, RS), for time windows and treatments. The study area was compared with the Swedish national data. Transfer times between municipalities, first hospitals, and thrombectomy centers were assessed using open data.

Results: The incidence of ischemic stroke in the study group was 280/100.000/year which was significantly higher than national data for the same age group. 1,153 stroke incidents were registered in RS. In the study group 21.1% arrived at the first hospital >24 h from start of symptoms compared to 4.5% in national data. Three percent were treated with thrombectomy and 11.1% with thrombolysis. The numbers were small but those with the lowest percentage of arrival < 3 h, and of reperfusion treatment, all had the longest distances to the first hospital. 26.1 and 17.9% in two municipalities had an unknown time window from start of symptoms. A majority of the population would have shorter distances to thrombectomy centers outside Sweden.

Conclusion: Our data shows a higher incidence of ischemic stroke in the study area in the rural northern Sweden. Persons with stroke in this area are unlikely to receive acute care in accordance with the Swedish national stroke guidelines.