Characteristics and reasons for delayed presentation in acute ischemic stroke: single-centered study in Indonesia

Effective therapy for acute ischemic stroke relies on timely intervention. We aimed to evaluate the factors associated with the onset-to-arrival time and delayed hospital presentation in acute ischemic stroke patients. Subjects with acute ischemic stroke in Bethesda Hospital Yogyakarta, Indonesia from March to June, 2023 were prospectively recruited. A questionnaire was used to collect the information by direct interviews. Prespecified variables were included in univariate and multivariable analyses to identify the predictors of delayed hospital presentation of more than 4.5 h. Among a total of 175 patients, 64.6% of the patients arrived at the hospital more than 4.5 h after the stroke onset. Only 3 (1.7%) patients were eligible and received intravenous thrombolysis. In multivariable analysis, monthly income of more than IDR 550,000 (OR, 4.22; 95% CI 1.47–12.17; p = 0.007), wake-up stroke or unknown stroke onset (OR vs. known onset, 0.17; 95% CI 0.05–0.56; p = 0.004), distance from location of stroke onset more than 9.45 km (OR, 3.13; 95% CI 1.41–6.92; p = 0.005) and no history of coronary artery disease or heart failure (OR vs. present history, 0.12; 95% CI 0.04–0.37; p = 0.000) were related to delayed hospital presentation. The most frequently mentioned reasons for the delay were waiting for spontaneous improvement at home and unawareness of the stroke symptoms. There is an enormous disparity in stroke services between developed and developing countries. This study highlighted the need to increase public stroke symptoms awareness.