Reply to: Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack

Dear Editor:

It was with great interest that we read the article by García Ruiz et al.¹ published in your journal under the title “Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack.” This study demonstrates that when stroke is witnessed by a patient’s daughter/son and presents greater severity, the delay in seeking help for stroke symptoms is reduced; emergency departments of hospitals in the Spanish national healthcare system are the main medical contacts in these cases¹. We observed the same findings in our sample of 425 patients from Northern Spain,² and similar factors have been associated with earlier hospital arrival in other countries³; therefore, these findings are robust and can be generalised. Another recurrent finding is that the number of patients contacting emergency services to seek help is much higher among patients seeking help in the first 15 minutes than among those seeking help later.^2,3 Unexpectedly, the reason for later hospital arrivals in cases in which emergency services were not contacted is not the transport time, but rather longer delays in seeking help.² The reduced delay when stroke is witnessed by a patient’s daughter/son may be explained by 2 facts: the witness may better identify the need for help; and witnesses are more easily able to seek assistance than a patient who is alone at stroke onset. However, the fact that greater stroke severity, regardless of the presence of a daughter/son, decreases the delay in seeking help suggests that the perception of the need for help reduces this delay more than stroke-derived motor impairment increases it. As extended families with grandparents, parents, and grandchildren living together continue to be replaced by nuclear families, help-seeking by a witnessing daughter/son will become less frequent. In stroke care protocols, time to hospital arrival is the longest; as has been observed in many countries during the COVID-19 epidemic, it is also the most likely to be affected by external circumstances⁴ and shows the most room for improvement. Therefore, we concur with García Ruiz et al.¹ that public awareness campaigns on emergency responses to stroke should stress the importance of immediate action in the event of mild symptoms, and focus on individuals presenting vascular risk factors or living alone.