World Stroke Day On Oct 29: Bengal Government Study Finds Over Half Of Stroke Patients Reach Hospitals Too Late

Being alone when a stroke strikes, mistaking its symptoms for something less serious or first visiting the wrong treatment facility can cost patients precious time. A study across 13 hospitals in West Bengal has found that more than half of stroke patients reached a stroke-ready hospital after the critical 4.5-hour window for a commonly used clot-busting treatment.

The findings reflect challenges that are also evident in national data, pointing to delays in seeking care, gaps in awareness and limited access to timely treatment.

Published in the Indian Journal of Medical Research, the study analysed 683 patients with acute ischaemic or haemorrhagic stroke. It found that 389 patients (56.9%) reached hospital more than 4.5 hours after symptoms began.

The findings point to gaps not only in public awareness but also in emergency transport and referral systems. Researchers found that patients who were unaware of the stroke treatment window had about 11 times the adjusted odds of delayed arrival. Those who were alone when symptoms began faced similarly high odds of reaching hospital late.

The study was conducted between March and May 2024 by researchers from the Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, and the West Bengal government’s health department across hospitals equipped to provide stroke care.

The researchers found that only 53 patients, or 7.8%, or their family members knew about the “golden hour of stroke”. Just 68 patients (10%) or their relatives could recognise the symptoms as a stroke. In most cases, the condition was recognised by a doctor.

Going to a facility other than a stroke-ready hospital was one of the strongest factors associated with delayed arrival. Patients who first visited another facility had 6.5 times the adjusted odds of reaching a stroke-ready hospital late.

Among patients who arrived after 4.5 hours, 42.9% cited admission to another hospital as a reason for the delay. Reluctance to seek medical care was reported by 32.3%, while 22.1% said they spent time arranging money. Nearly one in five reported visiting a traditional healer or an unqualified practitioner.

Of the 683 patients, 101 (14.8%) had initially visited a traditional healer or an unqualified practitioner. In 54 cases, the practitioner also failed to recognise the stroke, the study found.

Distance also mattered. Patients living more than 15 km from a stroke-ready hospital had 2.55 times the adjusted odds of delayed arrival. Those using public transport had three times the odds of delay compared with the reference transport category used in the analysis.

Night-time onset was associated with 1.81 times the odds of delayed arrival, while patients who woke up with stroke symptoms had about twice the odds. Experiencing vertigo and having a family history of stroke were also associated with delays.

The West Bengal findings echo concerns raised by a separate national analysis of 34,792 stroke cases recorded at 30 centres across India between 2020 and 2022. The study, published in the International Journal of Stroke and based on the ICMR-NCDIR Hospital-Based Stroke Registries, found that only 20.1% of patients reached hospital within 4.5 hours of symptom onset, while 37.8% arrived after 24 hours.

Nearly one in seven patients was aged below 45, and hypertension was the most common recorded risk factor, affecting 74.5% of patients. The national registry findings suggest that delayed presentation and gaps in treatment are not confined to one state, although hospital-based data do not represent every stroke case in the country.

In an ischaemic stroke, a blood clot blocks the flow of blood to part of the brain. Clot-busting treatment and mechanical thrombectomy can restore blood flow in eligible patients, but treatment decisions depend on the time elapsed, brain imaging and other clinical factors. For intravenous thrombolysis, the standard treatment window is generally up to 4.5 hours for eligible patients.

The West Bengal study also included haemorrhagic strokes, caused by bleeding in or around the brain. These require different treatment, but prompt hospital assessment remains essential because early management can help limit complications.

The researchers noted that late arrival at a stroke-ready hospital remains a major barrier to timely treatment. Such hospitals need facilities for brain imaging, access to appropriate treatment and trained staff available around the clock.

The authors said improving awareness of the treatment window was vital. They also pointed to the potential role of a more integrated telestroke system linking hospitals at different levels, so patients can be assessed and directed to suitable facilities without unnecessary transfers.

The authors cautioned that their findings should not be generalised to all of India because the study covered hospitals in only one state. However, viewed alongside national registry data, the findings underline the need for public education, quicker referrals and reliable emergency transport.

Dr Shailesh B Gaikwad, Head of the Department of Neuroimaging and Interventional Neuroradiology and Chief of the Neurosciences Centre at AIIMS, Delhi, who was not part of the study, stressed the importance of recognising stroke symptoms and acting without delay.

Ahead of World Stroke Day, marked on October 29, he said, "Sudden facial drooping, weakness in an arm or leg, or difficulty speaking should be treated as a medical emergency. Do not wait for symptoms to settle or spend time trying multiple treatment options. Seek emergency medical care immediately.

“Do not give aspirin, blood thinners, food or water unless a medical professional advises it. A stroke may be caused by bleeding rather than a clot, and medicines such as aspirin can worsen bleeding. Difficulty swallowing can also make eating or drinking unsafe,” he warned.

Dr Chetan Kumar A, Senior Consultant-Neurology at Sakra World Hospital, Bengaluru, said, “We see many patients with stroke every month. It is not limited to older adults; younger individuals can also be affected.

“While the risk generally increases with age, strokes can occur even in people in their 30s and 40s. Ischaemic stroke, which occurs when a blood clot blocks blood flow to part of the brain, is the most common type of stroke.”

The global burden underlines the urgency. The World Health Organization estimates that 11.9 million new strokes occurred worldwide in 2021, while about 93.8 million people were living with stroke and its consequences. It has also reported that the lifetime risk of stroke has risen substantially, with roughly one in four adults expected to experience a stroke during their lifetime.

Much of this burden is linked to preventable or modifiable risk factors. High blood pressure, smoking, unhealthy diets, physical inactivity, obesity, high blood sugar, high LDL cholesterol and air pollution are among the major contributors.

Advances in brain imaging, clot-removal procedures and emergency stroke care have expanded treatment options. However, their benefits depend heavily on timely recognition, rapid transport and access to suitable facilities, Gaikwad added.