Geographical location of ischemic stroke patients affects thrombolysis availability in Denmark

Introduction: Early recognition and treatment of stroke is paramount for good outcome. Transport distance may result in delayed arrival for revascularization therapy. We investigated how transport time and distance to the revascularization unit affected the probability of receiving intravenous thrombolysis in Denmark between 2015 and 2020, for patients calling the Emergency Medical Services within three hours of symptom onset. Methods: We obtained records from the Danish Stroke Registry (DanStroke) and the patient administrative computer-assisted dispatch system (CAD). All patients diagnosed with stroke from the Capital Region and Region Zealand, who contacted the EMS within three hours of symptom onset were included. The study population was analyzed using multivariate logistical regression models. Results: For the Capital Region, longer transport time was associated with lower IVT rates, with an Odds-Ratio 0.91, 95 % CI [0.83;0.99], P-value 0.0386. There was no significant correlation between transport time and IVT rates for the Region of Zealand. However, fewer patients with >60 min estimated transport time received IVT than patients with 0-20 min estimated transport time in the Region of Zealand (Odds-ratio 0.63, 95 % CI [0.44;0.91], p-value 0.016). Conclusions: Longer transport time to a revascularization unit is associated with significantly poorer IVT rates in the Capital Region of Denmark, despite calling in a timely manner for arrival within the 4.5-h treatment window. The same association was not established for the rural Region of Zealand; however, our findings do suggest that living >60 min from a revascularization unit is associated with a lower probability of receiving IVT in this region.