Objective: To evaluate factors that influence onset to arrival time of Acute Ischemic Stroke (AIS) patients at a Western Indian Neuroscience Institute.
Introduction: Thrombolytic therapy for AIS is in the developing stages in India. In order to increase availability of intravenous tissue plasminogen activator (IV rtPA) to AIS patients, it is essential to understand the current scenario and factors affecting onset to arrival time of AIS at Indian hospitals. Limited data is available regarding onset to arrival time and associated demographic, epidemiological and clinical characteristics of hospitalized AIS Indian patients.
Methods: Vadodara Institute of Neurological Sciences (VINS) is a standalone Neurological Hospital situated in Vadodara, India. Prospective data (onset to arrival time, demographics and clinical features) was collected on AIS patients admitted to VINS from June 2014 to July 2016. Onset to arrival time was stratified into 5 groups: < 3 hours, 3-4.5 hours, 4.5-6 hours, 6-24 hours and beyond 24 hours. Univariate and multivariate analysis was performed on collected data based on whether they arrived early (< 6 hours) or late (> 6 hours).
Results: Data was collected on 519 AIS patients of whom 55, 18, 32, 120 and 294 presented < 3 hours, 3-4.5 hours, 4.5-6 hours, 6-24 hours and beyond 24 hours respectively. Thus, 105 and 414 patients belonged to early and late arrival groups respectively. Univariate and multivariate analysis showed that higher educational status (p=.002), history of prior stroke (p=.0009), coronary artery disease (p=.0001) and atrial fibrillation (p=.0009) was associated with early arrival to the hospital. No difference was noted between the two groups with reference to age, sex, hypertension, diabetes, hyperlipidemia, smoking, mean NIHSS, hemiparesis or any cortical signs.
Conclusion: Patients presenting within the time window for IV rtPA (<4.5 hours) and intraarterial thrombectomy (< 6 hours) were 14% and 20% respectively in our cohort. Prior vascular events and higher educational status were associated with early arrival within the thrombolysis/thrombectomy treatment window for AIS. Grass-root level stroke education to communities with poor educational status can significantly enhance AIS thrombolysis treatment.