Association between a history of chronic diseases and ambulance use at the onset among first-ever stroke patients. the shiga stroke and heart attack registry study

Objective: It is essential to immediately call an ambulance and visit the medical institution specializing stroke. This study aimed to examine the differences in ambulance utilization at the onset of stroke, depending on the pre-stroke history of hypertension, diabetes, dyslipidemia, and atrial fibrillation. Design and method: First-ever stroke patients over 20 years old enrolled in part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry from January 1 to December 31, 2011, were analyzed. A logistic regression analysis was performed using the presence or absence of a history of each disease (hypertension, diabetes, dyslipidemia, atrial fibrillation), the independent variable (with the no history group as the reference group), and ambulance use at the onset of stroke as the dependent variable, and odds ratios (ORs) and 95% confidence intervals (95%Cis) for ambulance use in the no history group as the reference group was calculated. Results: Of the 2054 first-ever stroke patients analyzed, 1212 (59.0%) used an ambulance. The prevalence of each disease (percentage of patients who used an ambulance according to whether they had the disease or not, %) was 45.5% for hypertension (56.3%, 61.3%), diabetes 14.0% (46.7%, 61.0%), dyslipidemia 12.5% (51.0%, 60.2%), and atrial fibrillation 7.3% (68.5%, 58.3%). The multivariate-adjusted odds ratios and 95% confidence intervals for ambulance use at the onset of stroke for each disease were hypertension (ORs and 95% CI: 0.91, 0.73-1.12), diabetes (0.61, 0.45-0.81), and dyslipidemia. (0.90, 0.66-1.21) and atrial fibrillation (1.35, 0.89-2.04). Conclusions: From this regional stroke registry survey, it was not observed that patients with a history of hypertension, diabetes, dyslipidemia, and atrial fibrillation tend to use an ambulance at the onset of a stroke compared with those without it. Our study indicated that patient education regarding appropriate reaction/ response at the stroke onset might not be efficient among patients with chronic diseases, including hypertension. In addition to the information for primary disease control, information on the importance of requesting an ambulance at the onset of a stroke should be provided.