Abstract TMP73: The Community Engagement for Early Recognition and Immediate Action in Stroke (CEERIAS) Study: Primary Results

Abstract

Introduction: Early hospital arrival after stroke increases access to proven treatments and improves outcomes. We hypothesized that a community-engaged stroke preparedness intervention to overcome barriers to early activation of 9-1-1 would increase early hospital arrival and emergency medical services (EMS) use after stroke in high-risk neighborhoods in Chicago. Methods: We partnered with stakeholders in a South Side Chicago community with a high stroke incidence and in close proximity to a primary stroke center to develop a community stroke preparedness intervention. The intervention was delivered by “stroke promoters”, trained lay persons from the target neighborhood who utilized in-person discussions to overcome barriers and obtain stroke preparedness pledges as measured by “Pacts to Act FAST”. We applied an interrupted time-series analysis at the target hospital to study the effects of the intervention on EMS utilization and hospital arrival within 3 hours of symptom onset among patients with confirmed ischemic stroke. We compared these results to 6 North Side Chicago stroke centers and 17 St. Louis stroke centers as concurrent controls. Results: During a 12-month period, 242 stroke promoters distributed >110,000 educational materials, participated in 167 community events, and registered 39,975 Pacts to Act FAST, reaching 19.4% of residents in the target South Side neighborhoods. Early arrival increased (0.5%/month post-intervention; p=0.124 for slope change) at the target hospital but was not different compared to North Side hospitals (p=0.560) or St. Louis hospitals (p=0.072). The effect on early arrival was significant among patients <66 years old (0.8%/month increase; p=0.036), men (1.2%/month increase; p=0.026), and African-Americans (0.9%/month increase; p=0.037). No effect was observed on EMS use. Conclusions: Using a community-engaged approach to deliver a stroke preparedness intervention in Chicago, we observed a modest increase in early hospital arrival after confirmed stroke, which was more pronounced in younger, male, and African-Americans patients. Future efforts should consider improving message penetration and sustainability using novel personal approaches such as social media.