Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort: The Stroke Warning Information and Faster Treatment Study

Bernadette Boden-Albala, Joshua Stillman, Eric T. Roberts, Leigh W. Quarles, M. Maria Glymour, Ji Chong, Harmon Moats, Veronica Torrico, Michael K. Parides

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background and Purpose-Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors. Methods-A single-center randomized controlled trial (2005-2011) randomized participants to EE (bilingual stroke preparedness materials) or II (EE plus in-hospital sessions). We assessed differences by randomization in the proportion arriving to emergency department <3 hours, prepost intervention arrival <3 hours, incidence rate ratio for total events, and stroke knowledge and preparedness capacity. Results-SWIFT randomized 1193 participants (592 EE, 601 II): mean age 63 years; 50% female, 17% black, 51% Hispanic, 26% white. At baseline, 28% arrived to emergency department <3 hours. Over 5 years, first recurrent stroke (n=133), transient ischemic attacks (n=54), or stroke mimics (n=37) were documented in 224 participants. Incidence rate ratio=1.31 (95% confidence interval=1.05-1.63; II to EE). Among II, 40% arrived <3 hours versus 46% EE (P=0.33). In prepost analysis, there was a 49% increase in the proportion arriving <3 hours (P=0.001), greatest among Hispanics (63%, P<0.003). II had greater stroke knowledge at 1 month (odds ratio=1.63; 1.23-2.15). II had higher preparedness capacity at 1 month (odds ratio=3.36; 1.86, 6.10) and 12 months (odds ratio=7.64; 2.49, 23.49). Conclusions-There was no difference in arrival <3 hours overall between II and EE; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities.

Original languageEnglish (US)
Pages (from-to)1806-1812
Number of pages7
JournalStroke
Volume46
Issue number7
DOIs
StatePublished - Jul 4 2015
Externally publishedYes

Fingerprint

Hospital Emergency Service
Stroke
Therapeutics
Odds Ratio
Transient Ischemic Attack
Hispanic Americans
Incidence
Random Allocation
Survivors
Randomized Controlled Trials
Confidence Intervals

Keywords

  • acute stroke
  • health literacy
  • patient education
  • patient-centered outcomes research
  • preparedness

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort : The Stroke Warning Information and Faster Treatment Study. / Boden-Albala, Bernadette; Stillman, Joshua; Roberts, Eric T.; Quarles, Leigh W.; Glymour, M. Maria; Chong, Ji; Moats, Harmon; Torrico, Veronica; Parides, Michael K.

In: Stroke, Vol. 46, No. 7, 04.07.2015, p. 1806-1812.

Research output: Contribution to journalArticle

Boden-Albala, Bernadette ; Stillman, Joshua ; Roberts, Eric T. ; Quarles, Leigh W. ; Glymour, M. Maria ; Chong, Ji ; Moats, Harmon ; Torrico, Veronica ; Parides, Michael K. / Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort : The Stroke Warning Information and Faster Treatment Study. In: Stroke. 2015 ; Vol. 46, No. 7. pp. 1806-1812.
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abstract = "Background and Purpose-Less than 25{\%} of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors. Methods-A single-center randomized controlled trial (2005-2011) randomized participants to EE (bilingual stroke preparedness materials) or II (EE plus in-hospital sessions). We assessed differences by randomization in the proportion arriving to emergency department <3 hours, prepost intervention arrival <3 hours, incidence rate ratio for total events, and stroke knowledge and preparedness capacity. Results-SWIFT randomized 1193 participants (592 EE, 601 II): mean age 63 years; 50{\%} female, 17{\%} black, 51{\%} Hispanic, 26{\%} white. At baseline, 28{\%} arrived to emergency department <3 hours. Over 5 years, first recurrent stroke (n=133), transient ischemic attacks (n=54), or stroke mimics (n=37) were documented in 224 participants. Incidence rate ratio=1.31 (95{\%} confidence interval=1.05-1.63; II to EE). Among II, 40{\%} arrived <3 hours versus 46{\%} EE (P=0.33). In prepost analysis, there was a 49{\%} increase in the proportion arriving <3 hours (P=0.001), greatest among Hispanics (63{\%}, P<0.003). II had greater stroke knowledge at 1 month (odds ratio=1.63; 1.23-2.15). II had higher preparedness capacity at 1 month (odds ratio=3.36; 1.86, 6.10) and 12 months (odds ratio=7.64; 2.49, 23.49). Conclusions-There was no difference in arrival <3 hours overall between II and EE; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities.",
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AU - Boden-Albala, Bernadette

AU - Stillman, Joshua

AU - Roberts, Eric T.

AU - Quarles, Leigh W.

AU - Glymour, M. Maria

AU - Chong, Ji

AU - Moats, Harmon

AU - Torrico, Veronica

AU - Parides, Michael K.

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N2 - Background and Purpose-Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors. Methods-A single-center randomized controlled trial (2005-2011) randomized participants to EE (bilingual stroke preparedness materials) or II (EE plus in-hospital sessions). We assessed differences by randomization in the proportion arriving to emergency department <3 hours, prepost intervention arrival <3 hours, incidence rate ratio for total events, and stroke knowledge and preparedness capacity. Results-SWIFT randomized 1193 participants (592 EE, 601 II): mean age 63 years; 50% female, 17% black, 51% Hispanic, 26% white. At baseline, 28% arrived to emergency department <3 hours. Over 5 years, first recurrent stroke (n=133), transient ischemic attacks (n=54), or stroke mimics (n=37) were documented in 224 participants. Incidence rate ratio=1.31 (95% confidence interval=1.05-1.63; II to EE). Among II, 40% arrived <3 hours versus 46% EE (P=0.33). In prepost analysis, there was a 49% increase in the proportion arriving <3 hours (P=0.001), greatest among Hispanics (63%, P<0.003). II had greater stroke knowledge at 1 month (odds ratio=1.63; 1.23-2.15). II had higher preparedness capacity at 1 month (odds ratio=3.36; 1.86, 6.10) and 12 months (odds ratio=7.64; 2.49, 23.49). Conclusions-There was no difference in arrival <3 hours overall between II and EE; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities.

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KW - health literacy

KW - patient education

KW - patient-centered outcomes research

KW - preparedness

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