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Lower use of reperfusion therapy attributed to lower stroke recognition.
People with mental health troubles in recent years were less likely to have strokes treated with thrombolysis or thrombectomy, a finding that is likely in part due to lower recognition of stroke symptoms, according to a nationwide study from Denmark.
Out of over 19,000 stroke admissions from 2016 to 2017, reperfusion therapy was applied to 17% of patients — and even less in those with comorbid mental illness, regardless of severity:
- Minor mental illness: RR 0.79 (95% CI 0.72-0.86)
- Moderate mental illness: RR 0.85 (95% CI 0.72-0.99)
- Major mental illness: RR 0.63 (95% C 0.51-0.77)
When arriving at hospital within 4 hours (disregarding hospital level of stroke expertise) reperfusion therapy was still underutilized,” wrote Julie Mackenhauer, MD, and colleagues at the Danish Center for Clinical Health Services Research of Aalborg University. “We identified lower recognition of stroke symptoms in all steps of the stroke chain. This resulted in delays and lower rates of reperfusion treatment among patients with a history of mental illness, especially among patients with a history of major mental illness.”
“However, when stroke was recognized either in the prehospital setting or after hospital arrival, reperfusion treatment was undertaken equally fast, and a history of mental illness or mental vulnerability was not a barrier to acute stroke treatment,” the researchers reported in Stroke.
Their study elaborates on possible causal paths and mediating factors after a 2018 study from the U.S. also described lower odds of IV thrombolysis in stroke patients with psychiatric disease.
People with mental health troubles in recent years were less likely to have strokes treated with thrombolysis or thrombectomy, a finding that is likely in part due to lower recognition of stroke symptoms, according to a nationwide study from Denmark.
Out of over 19,000 stroke admissions from 2016 to 2017, reperfusion therapy was applied to 17% of patients — and even less in those with comorbid mental illness, regardless of severity:
- Minor mental illness: RR 0.79 (95% CI 0.72-0.86)
- Moderate mental illness: RR 0.85 (95% CI 0.72-0.99)
- Major mental illness: RR 0.63 (95% C 0.51-0.77)
“When arriving at hospital within 4 hours (disregarding hospital level of stroke expertise) reperfusion therapy was still underutilized,” wrote Julie Mackenhauer, MD, and colleagues at the Danish Center for Clinical Health Services Research of Aalborg University. “We identified lower recognition of stroke symptoms in all steps of the stroke chain. This resulted in delays and lower rates of reperfusion treatment among patients with a history of mental illness, especially among patients with a history of major mental illness.”
“However, when stroke was recognized either in the prehospital setting or after hospital arrival, reperfusion treatment was undertaken equally fast, and a history of mental illness or mental vulnerability was not a barrier to acute stroke treatment,” the researchers reported in Stroke.
Their study elaborates on possible causal paths and mediating factors after a 2018 study from the U.S. also described lower odds of IV thrombolysis in stroke patients with psychiatric disease.
Mackenhauer and colleagues estimated total prehospital delays being approximately 67 minutes longer, after adjustment, in stroke patients with a history of major mental illness compared with peers with no history of mental illness. The difference widened to 123 minutes among those who had been admitted without an EMS call.
“Longer delays from symptom onset to hospital arrival contributed to the patients’ risk of not being eligible for reperfusion therapy,” the authors said. “Stigma related to mental illness may contribute to the observed differences.”
