Rural Swedish stroke patients face dangerous delays in emergency care
A new study of remote northern Sweden reveals that patients experiencing strokes in sparsely populated areas wait significantly longer to reach hospitals equipped for lifesaving treatment. The findings highlight a critical gap in healthcare access that policymakers and hospital networks must address to prevent deaths and permanent disability in underserved regions.
Originaltitel: Acute treatment of ischemic stroke in 19 Sámi language administrative municipalities in the rural inland of Northern Sweden.
Strokebehandlingen i inlands-Norrbotten når långt ifrån samma standard som i Sverige för övrigt. En studie från Uppsala universitet undersökte 142 127 människor i 19 Sámiregioner under 2019–2021 och fann en strokeincidenstal på 280 per 100 000 årligen — betydligt högre än riksgenomsnittet för motsvarande åldersgrupp. Kritiskt är att 21,1 procent av patienterna anlände till sjukhus mer än 24 timmar efter symptomstart, mot 4,5 procent nationellt. Endast 3 procent erhöll trombektomi och 11,1 procent trombolys. Kommuner med längst restid till akutsjukhus uppvisade lägst behandlingsfrekvenser och senast ankomst. I två kommuner var tidsfönstret från symptomstart okänt för 26,1 respektive 17,9 procent av fallen. Resultaten indikerar att geografisk isolation är en kritisk barriär för strokeomsorgen — en utmaning för landsbygdspolitiken och framtida sjukvårdsplanering i nordliga regioner.
OBJECTS: The effective treatment of acute stroke requires a series of events, including the recognition of stroke symptoms, following known action plans, and the rapid transfer to a hospital with sufficient medical competence. This is challenging in rural areas with long distances between hospitals with emergency departments. We studied the availability and effectiveness of acute stroke treatment in the most rural parts of northern Sweden. Some of the population in the study area belong to the Sámi, Sweden's indigenous people. Our aim was to study the yearly incidence of ischemic stroke, time window from start of symptoms to arrival at first hospital, and rate of revascularization treatment in the study population and compare to the rest of Sweden. METHODS: Statistics Sweden defined the study group which was 142,127 individuals registered as living in the study area sometimes during 2019-2021. We used data from the National Board of Health and Welfare (NBHWF) regarding incidence and from the Swedish Stroke Register (Riksstroke, RS), for time windows and treatments. The study area was compared with the Swedish national data. Transfer times between municipalities, first hospitals, and thrombectomy centers were assessed using open data. RESULTS: The incidence of ischemic stroke in the study group was 280/100.000/year which was significantly higher than national data for the same age group. 1,153 stroke incidents were registered in RS. In the study group 21.1% arrived at the first hospital >24 h from start of symptoms compared to 4.5% in national data. Three percent were treated with thrombectomy and 11.1% with thrombolysis. The numbers were small but those with the lowest percentage of arrival < 3 h, and of reperfusion treatment, all had the longest distances to the first hospital. 26.1 and 17.9% in two municipalities had an unknown time window from start of symptoms. A majority of the population would have shorter distances to thrombectomy centers outside Sweden. CONCLUSION: Our data shows a higher incidence of ischemic stroke in the study area in the rural northern Sweden. Persons with stroke in this area are unlikely to receive acute care in accordance with the Swedish national stroke guidelines.