Are there differences between rural and urban populations in long-term outcome after systemic cerebral thrombolysis in a hospital located in an agricultural region?

Introduction: It is generally considered that rural hospitals have a much lower capacity to adequately care for patients with acute ischemic stroke (AIS). Analysis of the demographic and logistic factors affecting the outcome of intravenous (IV) thrombolysis in patients with AIS in a rural hospital are presented.

Methods: The observational study included 300 patients with AIS who were consecutively treated with IV thrombolysis. Long-term outcome and hemorrhagic complication rate in patients from rural and urban populations were compared.

Results: A total of 60.7% of patients were transported from rural areas. In the rural patients thrombolytic therapy at night was performed less frequently compared to that for urban patients (p=0.01). There were no differences in frequency of treatment between rural and urban patients treated with IV thrombolysis on weekends and on working days (p=0.47). In rural patients mortality was higher (p=0.04). The presence of hemorrhagic transformation (HT) (p=0.87) and of symptomatic intra-cerebral hemorrhage (SICH) (p=0.61) were similar in both groups. A multivariate analysis showed no impact of place of onset on favorable outcome after 3 months (p=0.9), on the presence of (SICH) (p=0.43) or on mortality rate (p=0.69).

Conclusions: Patients from rural areas are less likely to be treated with IV thrombolysis during the night. Rural and urban patients treated in the hospital located in the agricultural region had a similar efficacy and safety profile of thrombolytic treatment.