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Wake Up To Stroke -- Night Strokes Linked To Long Delays In Care

f health environments, the researchers studied patients in the Carolinas, where death rates from stroke are twice the national average, and in Colorado, where stroke death rates are much lower.

Researchers found that one-third of patients noticed stroke symptoms upon awakening. When the onset of stroke occurred between 10 p.m. and 2 a.m., up to 11 hours passed before the patient arrived at the hospital. Individuals whose symptoms occurred between noon and 4 p.m. delayed arriving at the hospital by only 2.5 hours. The median time of arrival at the hospital was 5.5 hours for those who awoke with symptoms, compared to 2.5 hours for those whose symptoms first appeared while awake.

Regardless of when the stroke occurred, more than one-half of all patients took more than four hours after the onset of symptoms to arrive at the hospital.

"Clot-busting drugs must be given within three hours of the onset of symptoms to be effective at all," says Rosamond. "Fifty percent don't even get to the hospital within four hours. Then you must add in the time it takes for evaluation and diagnostic tests, like a computer tomography scan, to allow physicians to determine if the stroke should be treated with a clot-buster. Strokes caused by bleeding in the brain -- hemorrhagic strokes -- are not treated with clot busters, because the drugs can increase the bleeding which can lead to death.

"A substantial proportion of patients are asleep when the symptoms occur," says Rosamond. "When that happens, their delay time in getting to the hospital is much longer, since the last time they were known to be symptom free might have been when they went to bed, making identification of the exact time of onset difficult. We need to find a way for people to understand stroke symptoms and treat them as a dire emergency so they will get to the hospital sooner, and we need to find new ways to improve care for the one-third of patients who awaken with symptoms of stroke."

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Contact: Carole Bullock
caroleb@heart.org
214-706-1279
American Heart Association
25-Mar-1999


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