Beyond the golden hour: prehospital delay and in-hospital stroke mortality in an elderly cohort reaching a national emergency-medicine center in Kazakhstan.

Authors

Aigul A Abduldayeva, Aliya M Omarbek, Gulnur N Doszhanova, Yerzhan B Adilbekov, Nikolay A Safonov, Saule A Iskakova

Published in

Frontiers in neurology. Volume 17. Pages 1916069. Epub Aug 18, 2026.

Abstract

Stroke remains a leading cause of death and disability worldwide, and the "time-is-brain" paradigm frames prehospital speed as the principal modifiable determinant of outcome. Data from Kazakhstan, a country of about 2.72 million km² with a population density of roughly 7 inhabitants per km², are scarce, and it is unclear whether time metrics retain their prognostic role where most patients present outside reperfusion windows. We retrospectively analyzed 149 elderly patients (aged 57-75 years) with neuroimaging-confirmed acute stroke admitted to the National Coordination Center for Emergency Medicine (Astana, Kazakhstan) in 2025-2026; transient ischaemic attacks were excluded. Prehospital time, transport mode, reperfusion, neurological severity (NIHSS), comorbidity and in-hospital mortality were assessed using Spearman correlation, ANOVA and logistic regression. Ischemic stroke predominated (122/149; 81.9%). The median onset-to-door time was 9.5 h (IQR 3.0-48.3 h; range 25 min to 264 h), and only 36.5% arrived within the 4.5-h thrombolysis window; delays were longest in hemorrhagic stroke (median 24.8 h). Reperfusion therapy reached 24.6% of ischemic-stroke patients (thrombolysis 9.0%, thrombectomy 15.6%), whereas 67.2% were managed conservatively. Despite these delays, in-hospital mortality was low (6.8%). Onset-to-door time predicted neither in-hospital death (adjusted OR 1.00 per hour; p = 0.99) nor discharge functional status (modified Rankin Scale r = -0.013, p = 0.87); in a pre-specified Firth penalized model the predictors of death were baseline NIHSS (penalized OR 1.22 per point; 95% profile-likelihood CI 1.12-1.37; p < 0.001) and cardiac arrhythmia (penalized OR 5.51; 95% CI 1.07-29.71; p = 0.041). The crude mortality contrast (29.4% vs. 3.8%) is descriptive and hypothesis-generating. Baseline NIHSS was inversely correlated with onset-to-door time (r = -0.193; p = 0.019), indicating that later-presenting patients were less severely affected. These findings apply specifically to elderly patients who survived to reach the center and are not causal: the severity-time and time-mortality associations reflect who reaches the center. Within this hospital-admitted cohort, in-hospital mortality appears governed by neurological severity and cardiac comorbidity rather than transport time, supporting risk-based triage, arrhythmia detection, regionalized routing and air-ambulance capacity alongside efforts to compress door times.

PMID:
42682469
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.

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