Educational program reduces prehospital delays for stroke patients in China

The introduction of a multifaceted educational campaign was associated with significant improvements in ambulance use and hospital arrival times for patients with stroke, according to a study published in JAMA Network Open.

“Stroke is a leading cause of death in China, resulting in more than 1.5 million deaths every year,” Jing Yuan, PhD, of the School of Pharmacy at Fudan University, and colleagues wrote. “The mortality rate of stroke in China is five times that of Europe and the U.S. ... Based on the current best estimate, the median hospital delay time for patients with stroke in China was nearly 15 hours, almost five times the recommended 3 hours.”

Yuan and colleagues aimed to investigate associations between the Stroke 1-2-0 campaign, an outreach program launched in China to improve stroke symptom awareness and changes in prehospital delays for patients with ischemic stroke. The campaign, which targeted patients and community members, included videos, print materials, news and in-person education.

Researchers conducted a population-based, cross-sectional study and included 2,857 patients with ischemic stroke (mean age, 69.83 years; 62.1% men) who were admitted to Minhang Hospital in Shanghai between Jan. 1, 2016, and Dec. 31, 2019. An interrupted time-series analysis was performed to determine the proportion of patients who arrived at the hospital within 3 hours and used an ambulance for medical attention, as well as the odds of seeking medical assistance within 3 hours following a stroke, both before and after introduction of the campaign.

Researchers found that after initiation of Stroke 1-2-0, the median prehospital delay time decreased from 18.72 hours (7.44-27.84) to 6.00 hours (2-16.35), the proportion of patients with hospital arrival time within 3 hours increased from 5.8% to 33.4% and ambulance use increased from 3.2% to 30.6%.

Interrupted time series analysis also revealed that initiation of the campaign was associated with significantly increased odds of arriving at the hospital within 3 hours (OR = 8.01; 95% CI, 7.17-8.95) and ambulance use (OR = 9.41; 95% CI, 8.24-10.74).

“Local adaptations of the Stroke 1-2-0 campaign are needed given the health disparities in urban and rural areas and economic development in different regions of China,” Yuan and colleagues wrote.