Stroke - from symptoms to survival

Abstract

Background: Stroke onset requires prompt medical care; however, symptoms may be difficult to interpret, contributing to delays in hospital arrival. Secondary preventive medications after ischemic stroke are important, but socioeconomic disparities may affect their dispensing. Although stroke incidence and mortality have declined in high- income countries, stroke remains a leading cause of death. Overall aim: To investigate symptom presentation and decision-making at stroke on- set, socioeconomic factors in secondary preventive medication dispensing, and short- and long-term survival following ischemic stroke. Methods: Content analysis was applied in paper I and Grounded theory in paper II. In papers III and IV, register-based data were analysed using statistical methods. Results: Stroke symptoms were reported in diverse ways, and the decision-making process was complicated, often driven by fear, which could delay seeking emergency care. Dispensing of secondary preventive medications after ischemic stroke was more strongly associated with low family income than with low educational level. Survival after ischemic stroke improved from 1987 to 2021, particularly in the short-term, although early mortality remained high. Conclusions: Interpreting stroke symptoms and decision-making at stroke onset is complex; it is crucial to seek emergency care at the very first sign of a stroke. Socioeconomic disparities in secondary preventive medications persist, underscoring the need to address inequalities. Both short- and long-term survival following ischemic stroke have improved over time; nevertheless, early mortality remains substantial.