Public Release: 

Making the 9-1-1 call for stroke differs by race, sex

American Heart Association Rapid Access Journal Report

American Heart Association

DALLAS, August 12, 2015 - During a stroke, slightly more than half of patients use emergency medical services (EMS) to get to the hospital, with white women the most likely, and Hispanic men the least likely to use EMS transport, according to new research in Journal of the American Heart Association.

Between October 2011 and March 2014, researchers analyzed medical records from nearly 400,000 stroke patients admitted to more than 1,600 hospitals participating in the American Heart Association/American Stroke Association's Get With The Guidelines®-Stroke, a quality initiative to improve stroke treatment. Fifty percent of stroke patients were women, 69 percent were white, 19 percent were black, 8 percent were Hispanic and 3 percent were Asian. Average age was 71, and most had the most common type of stroke which is caused by a blocked blood vessel.

Researchers found:

Women were overall more likely than men to use EMS in the event of a stroke, with 62 percent of white women being transported by EMS.

  • About 58 percent of black women and men used EMS.
  • About 57 percent of Asian women and white men used EMS.
  • About 55.5 percent of Hispanic women and Asian men used EMS.
  • The group least likely to use EMS was Hispanic men, at a little more than 52 percent.

"These findings are critically important because a significant predictor of stroke-related disability is the time interval between symptom onset and medical treatment," said Heidi Mochari-Greenberger, Ph.D., M.P.H., lead author of the study and an associate research scientist at Columbia University Medical Center in New York, N.Y. "The use of emergency medical service transport is associated with shorter hospital arrival times."

Fast treatment is critical during a stroke to restore blood flow to the brain and prevent tissue damage, and limit disability. Experts recommend calling 9-1-1 immediately upon noticing stroke symptoms. These symptoms and the recommended action are easily remembered by the acronym F.A.S.T for: face drooping; arm weakness; speech difficulty; time to call 9-1-1.

Yet, many people experiencing stroke symptoms do not receive timely treatment. Evidence shows that blacks are more likely to die from a stroke than whites and that blacks and other minorities have more disability after a stroke than non-Hispanic whites. Since the reasons for these differences are unclear, the researchers sought to determine whether they might be related to 9-1-1 use.

In other findings that confirm previous research, the researchers found that patients with well-recognized stroke symptoms, such as weakness, speech difficulty, or altered consciousness, were much more likely to use EMS than people with less well-known symptoms.

"This information highlights a need for healthcare providers to educate patients and their families about stroke warning signs and taking action to call 9-1-1," Mochari-Greenberger said. "Calling 9-1-1 at the time of stroke onset not only may increase the likelihood of one's own survival, but those who are educated may also be in a position to save a life if they observe stroke symptoms in someone else and call emergency medical services immediately."


Co-authors are Ying Xian, M.D., Ph.D.; Anne S. Hellkamp, M.S.; Phillip J. Schulte, Ph.D.; Deepak L Bhatt, M.D., M.P.H.; Gregg C. Fonarow, M.D.; Jeffrey L. Saver, M.D.; Mathew J. Reeves, Ph.D.; Lee H. Schwamm, M.D.; and Eric E. Smith, M.D., M.P.H. Author disclosures are on the manuscript.

The American Heart Association/American Stroke Association supported the study. Past supporters of Get With The Guidelines®-Stroke include Boeringher-Ingelheim; Merck; Bristol-Myers Squib/Sanofi Pharmaceutical Partnership; Janseen Pharmaceutical Companies of Johnson & Johnson; and the American Heart Association Pharmaceutical Roundtable.

Additional Resources:

Researcher photo, F.A.S.T. graphic, and brain illustrations are located in the right column of this release link

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