Geographical differences in thrombolysis treatment for acute ischaemic stroke.

Background: Administering intravenous thrombolysis (IVT) as soon as possible after symptom onset impacts on the functional outcome for patients with acute ischaemic stroke. The study aimed to assess whether the distance from hospital impacts on the access to IVT for acute ischaemic stroke at the University Hospital of North Norway in Tromsø (UNN Tromsø).

Material and method: This prospective quality study included 231 patients admitted with acute ischaemic stroke to UNN in the period 1 January 2019-31 December 2019. The patients were divided into two groups based on vehicle transport time by road to the hospital at symptom onset: the urban cohort (≤ 30 minutes) and the rural cohort (> 30 minutes). Information on patient characteristics, IVT administration and functional status was retrieved from the Norwegian Stroke Registry, and prehospital timelines were retrieved from the Acute Medical Information System (AMIS). Outcome measures were the proportion of patients treated with IVT, and the time from symptom onset to thrombolysis.

Results: At symptom onset, 108 of the 231 patients were in an urban area and 123 were in a rural area. The urban cohort included fewer men (54 % vs. 68 %), a lower proportion with good functional status (a score of 0-1 on the Modified Rankin Scale) before symptom onset (58 % vs. 73 %) and fewer patients admitted via the local out-of-hours medical centre (10 % vs. 28 %) than the rural cohort. The proportion of patients treated with IVT in the urban cohort was 38 %, compared to 23 % in the rural cohort. On average, the urban cohort received the treatment 75 minutes sooner than the rural cohort.

Interpretation: The findings indicate that patients who are further from the hospital at symptom onset receive IVT less frequently and with a greater delay, and therefore have a lower likelihood of a favourable treatment outcome. Direct access to decentralised IVT could improve the treatment provision for ischaemic stroke patients.