Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Do patient and service factors influence medication management of patients with acute stroke in a regional Emergency Department? (#80)

Jaclyn Birnie 1 , Dianne Marsden 2 , David Schmidt 3 , Carlos Garcia Esperon 4
  1. Armidale Hospital, HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT, ARMIDALE, NSW, Australia
  2. Hunter Stroke Service, HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT, NEWCASTLE, NSW, Australia
  3. Rural and Remote Portfolio, HEALTH EDUCATION AND TRAINING INSTITUTE, SYDNEY, NSW, Australia
  4. Acute Stroke Service, John Hunter Hospital, HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT, NEWCASTLE, NSW, Australia

Background: Regional hospitals have less access to stroke specialists and lower compliance with stroke clinical guidelines compared to metropolitan hospitals. Previous stroke studies in Emergency Departments (EDs) have focused on reperfusion treatments (thrombolysis and thrombectomy) for acute ischaemic stroke. Arrival to hospital by ambulance, arriving sooner after onset and being in a metropolitan hospital are associated with receiving reperfusion treatments.

Aims: To determine the extent to which patients with acute stroke in a regional ED receive optimal management (hyperacute or secondary prevention medication management) compared to stroke clinical guidelines. To explore patient and service factors associated with optimal management in ED.

Methods: Medical records of 304 consecutive patients presenting with acute stroke from 2019-2021 were included. Data regarding optimal management were compared to stroke clinical guidelines. Relationships between patient and service factors and optimal management were explored using logistic regression.

Results: Fourteen people presented with haemorrhagic stroke (5%), 88 with ischaemic stroke (29%) and 202 with suspected ischaemic stroke/transient ischaemic attack (TIA) (66%). Optimal management was achieved for 86% of haemorrhagic, 86% of ischaemic, 64% of suspected ischaemic stroke/TIA. Telehealth input from a stroke specialist was the strongest predictor in achieving optimal management (adjusted odds ratio (aOR) (95% confidence interval (95% CI)): 4.95 (2.45-10.32)). Longer to attend ED (aOR (95%CI): 3.76 (1.43-10.11), presenting during 2021 (aOR (95%CI): 1.50 (1.06-2.13)), or having a suspected ischaemic stroke/TIA (aOR (95%CI): 2.28 (1.02-5.35)) were associated with suboptimal management.

Conclusion: Optimal management was achieved for a high proportion of patients with haemorrhagic and ischaemic stroke. The strongest predictor for receiving optimal medication management was receiving acute telehealth input from a stroke specialist. This was true for the small number of patients who received reperfusion treatments and also for patients who received guideline-recommended secondary prevention medication management in ED.