Prospective analysis of stroke recognition, stroke risk factors, thrombolysis rates and outcomes in Indigenous Australians from a large rural referral hospital

Angela Dos Santos; Katherine Mohr; Martin Jude; Neil G Simon; Mark Parsons; Sandra Eades; Luke Burchill; Stephen Davis; Geoffrey Donnan; Leonid Churliov; Candice Delcourt

doi:10.1111/imj.15080

Prospective analysis of stroke recognition, stroke risk factors, thrombolysis rates and outcomes in Indigenous Australians from a large rural referral hospital

Intern Med J. 2022 Mar;52(3):468-473. doi: 10.1111/imj.15080.

Authors

Angela Dos Santos^{1

2}, Katherine Mohr³, Martin Jude^{3

4}, Neil G Simon⁵, Mark Parsons^{1

2}, Sandra Eades², Luke Burchill², Stephen Davis¹, Geoffrey Donnan¹, Leonid Churliov^{2

6}, Candice Delcourt^{7

8}

Affiliations

¹ Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, VIC, Australia.
² The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
³ The Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia.
⁴ The University of New South Wales, Rural Clinical School, Wagga Wagga, NSW, Australia.
⁵ Northern Clinical School, The University of Sydney, North Sydney, NSW, Australia.
⁶ Department of Medicine (Austin Health), The University of Melbourne, Parkville, VIC, Australia.
⁷ The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia.
⁸ Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia.

PMID: 33012066
DOI: 10.1111/imj.15080

Abstract

Background: Cardiovascular disease is the most common cause of death and disability in indigenous communities but limited prospective data exist about stroke.

Aims: To estimate the difference in stroke recognition, risk factors, treatment rates and outcomes between indigenous and non-indigenous peoples admitted to the Wagga Wagga Rural Referral Hospital (WWRRH) over a 5-year period with a suspected acute stroke.

Methods: All suspected strokes presenting to the 33 peripheral hospitals within the Murrumbidgee Local Health District (MLHD) were transferred to the WWRRH and prospectively assessed over a 5-year period from 1 January 2012 to 31 December 2017. Actions at stroke onset, risks factors, stroke type, treatment and outcomes were analysed.

Results: A total of 1843 patients were included. Of these, 45 (2.5%) patients were indigenous. Only 26.6% of indigenous and 34% of non-indigenous patients knew of the face, arm, speech, time (FAST) acronym. Indigenous patients were younger (mean age 62.0 years vs 74.4 years) and more likely to have diabetes (risk difference (RD) 22.3% (95% CI: 3%, 41.7%)), dyslipidaemia (RD 19.4% (95% CI: 21.%, 36.7%)), and be ever smokers (RD 24.9% (95% CI: 9.5%, 40.3%)). Stroke types were similar except lacunar infarcts were more common (19.2% vs 8.4%). Treatment rates and outcomes were similar between the two groups.

Conclusions: Indigenous Australians with stroke are a decade younger and have a higher prevalence of important, modifiable stroke-risk factors. Delayed presentation to hospital is more common, due in part to stroke symptoms being underrecognised. When admitted to a specialised stroke unit, treatment rates and outcomes are comparable.

Keywords: Indigenous Australians; risk factors; rural; stroke; thrombolysis.

MeSH terms

Australia / epidemiology
Hospitals, Rural
Humans
Middle Aged
Native Hawaiian or Other Pacific Islander*
Referral and Consultation
Risk Factors
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / therapy
Thrombolytic Therapy

Grants and funding

The Australian Government Research Training Progra/Australian Commonwealth Government