Canadian-led international study shows huge costs of delayed access to stroke care

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It has been known for years that it is important to get stroke patient’s treatment as soon as possible to increase their chances of recovery. A Canadian-led international study that was presented at the 11th World Stroke Congress (17–20 October, Montreal, Canada) quantifies how important every hour can be—both for patients and for costs to society and the healthcare system.

The study, led by clinicians at the University of Calgary (Calgary, Canada), found that every hour of delay resulted in shortened or diminished quality of life as well as substantially higher healthcare and societal costs.

“Faster treatment results in better outcomes and better quality of life,” said Michael Hill of the Department of Clinical Neurosciences at the University of Calgary, one of the study authors. “The speed of treatment is one of the modifiable factors that will improve outcomes and reduce cost at both the system and the hospital level.”

Study collaborators from the USA, UK, France, Spain, Netherlands and Australia joined the Canadian researchers in examining outcome records and treatment costs for patients who had an ischaemic stroke and were eligible for endovascular thrombectomy (EVT). With EVT, a person with an ischaemic stroke has the clot physically removed as soon as possible after symptoms start. The process involves threading a thin tube through an artery and guiding it with X-ray imaging through blood vessels to the brain. A retrievable stent is used to remove the clot. The procedure has shown remarkable results in studies, reducing the overall death rate by 50% and greatly diminishing the lasting effects of stroke in many patients.

The study concluded that within the first six hours, every hour of delay in starting the EVT procedure resulted in an average loss for the patient of nine months at full quality of life (known as a quality-adjusted life year or QALY), or 18 months less at 50% quality of life due to disabilities.

As for cost, the study found every hour of delay within the first six hours resulted in increased healthcare costs of US$6,173 per QALY and society costs of US$7,597 per QALY.

The losses are even greater during the very first hours after a stroke occurs. Within the first three hours, the study found, treatment delay of two hours—that are typically spent getting a patient to a stroke centre, evaluated, and brain imaged, even in relatively good circumstances—would result in average losses for the patient of close to two QALYs (two years) and extra healthcare and societal costs of US$11,000 and US$15,000 per QALY (year), respectively.

A further ‘hot topic’ presentation at the World Stroke Congress outlined a study—led by Patrice Lindsay of Heart & Stroke—that looked at pre-hospital behaviour of young stroke patients compared to older ones. The study found that young adults (ages 18–44), especially women, were less likely to take an ambulance to the hospital when they had a stroke.

Researchers studied 2003–2016 data from the Canadian Institute for Health Information to compare hospital arrival times after stroke based on gender and age. At the same time, they looked at public polling data to analyse stroke awareness among different groups.

Hospital arrival time was an average seven hours for older adults and younger men, but nine hours in younger women. Yet, polling showed that more women knew at least one FAST sign of stroke compared to men.

“Young adults, especially women, are less likely to use ambulance services and more likely to arrive to hospital late, even though they have more knowledge of stroke,” Lindsay says. “Targeted public health messaging is required to ensure younger adults seek timely stroke care.” Every hour of delay causes poorer outcomes after stroke and diminished quality of life.

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