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Patients With Known Risk Factors For Stroke Delay Seeking Help: Presented at ESC

By Bruce Sylvester
Special to DG News

GENEVA, SWITZERLAND -- June 4, 2002 -- People who have risk factors for stroke -- hypertension or diabetes -- do not seek emergency help any more quickly than others, researchers reported here Saturday at the European Stroke Conference (ESC).

"The most important implication of this study is the self-perceptions of certain at-risk patients who are having signs and symptoms of stroke," said lead investigator C.H.Nolte, MD, resident and medical researcher at Charite Hospital in Berlin, Germany. "People who have risk factors for stroke such as hypertension and diabetes do not react faster than others."

As part of the larger Berlin Acute Stroke Study, the researchers assessed pre- and in-hospital delays among stroke patients with diagnosed hypertension and/or diabetes.

"People who have a diagnosed heart condition that causes discomfort are accustomed to getting to a doctor or hospital immediately at the sign of a problem. Diabetes and hypertension don't hurt, so people at risk of stroke from these causes might not be used to thinking 'emergency' and going to the hospital at the first signs of such an acute health situation as a stroke." Dr. Nolte added.

The researchers evaluated prospectively 1094 patients who were enrolled at admission to four hospitals in central Berlin for signs of stroke from August 2000 to September 2001. They used a structured interview to document pre-hospitalization behaviour and used medical records to study in-hospital care management.

A total of 625 patients (58 percent) were eligible for a study interview. These patients had a mean age of 66.3±13.7 years; 46 percent were women; their mean National Institutes of Health Stroke Scale score was 5.2±4.8; and 82 percent had ischemic stroke. The investigators categorized patients according to whether or not they were hypertensive and/or diabetic.

Sixty-five percent of the subjects said they had hypertension and/or diabetes; 35 percent said that they had not been diagnosed with either condition. Median delay from the time of awareness of stroke symptoms to arriving at a hospital emergency room was 304 minutes for those with hypertension and/or diabetes and 194 minutes for those who had neither condition (p=0.08).

Forty-six percent of each group used emergency transportation to hospital. Median time from arrival to receiving a head computed tomography scan was 111 minutes for declared hypertensives/diabetics and 114 for the others.

Subjects with risk factors were significantly older (p<0.01), but age did not appear to determine differences in mean delay times between the groups. The groups showed no differences in stroke severity or gender distribution.

"We presume that current awareness of an increased risk for stroke and appropriate behavior to stroke symptoms is not sufficient," the authors wrote.

"If you want to educate the public to seek emergency help if they have signs and symptoms of stroke, you have to focus on educating the people with risk factors, particularly hypertension and diabetes. These conditions won't train people, like a heart condition often does, to automatically seek medical attention at the first sign of a problem. But it's because they are silent that, vis a vis acute stroke, they can be so dangerous and delay of treatment can be so devastating," Dr. Nolte said.

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