{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:50:22Z","timestamp":1792464622671,"version":"4.5.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Many national initiatives focus on promoting early hospital arrival of patients with acute ischemic stroke (AIS) because treatment effectiveness is time-dependent. However, several studies reported time-delays in hospital arrival, especially during the COVID-19 pandemic. Our purpose was to evaluate the 10-year trends in last known well to arrival (LKWA) time and assess disparities in patients with AIS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A retrospective study of consecutive patients with AIS in the United States admitted to a large, socioeconomically diverse health care system in the New York metropolitan area was performed from 2014 to 2023. LKWA time groups were categorized according to treatment eligibility: 0 to 4.5, &gt;4.5 to 24, and &gt;24 hours. Demographic and clinical characteristics, treatment utilization, and modified Rankin Scale at discharge were extracted from electronic health records. Trend, bivariable, and multivariable logistic regression analyses were conducted.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              A total of 11\u2005563 patients with AIS were included with 53% (6163) LKWA 0 to 4.5, 34% (3988) LKWA &gt;4.5 to 24, and 12% (1412) LKWA &gt;24 groups. From 2014 to 2023, there was a significant downtrend in the early LKWA 0 to 4.5 (61%\u201346%) with uptrends in the later LKWA &gt;4.5 to 24 (31%\u201343%) and LKWA &gt;24 (8%\u201311%) groups (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). In the LKWA &gt;4.5 groups, the gap widened between racial categories after COVID (2021\u20132023;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.004). Compared with LKWA 0 to 4.5, the LKWA &gt;4.5 to 24 group was less likely to receive endovascular thrombectomy (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001) and more likely to have worse outcomes (modified Rankin Scale, 2\u20135;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). LKWA &gt;4.5 groups were more likely to be older &gt;80 years of age (odds ratio, 1.33 [95% CIs, 1.11\u20131.58]), men (1.11 [1.03\u20131.20]), Black patients (1.21 [1.09\u20131.34]), Asian patients (1.20 [1.03\u20131.39]), Medicaid insurance (1.18 [1.08\u20131.29]), and low-income &lt;$80\u2005000 (1.39 [1.20\u20131.61]).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In the past decade, there was a significant uptrend in patients with AIS arriving in the late LKWA &gt;4.5 groups. Socioeconomic disparities were observed with a persistent uptrend in non-White patients in the late LKWA &gt;4.5 groups after the COVID pandemic. These findings highlight the need to implement targeted efforts to improve disparities in LKWA time in patients with AIS.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.049169","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T05:00:16Z","timestamp":1738213216000},"page":"591-602","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Ten-Year Trends in Last Known Well to Arrival Time in Acute Ischemic Stroke Patients: 2014 to 2023"],"prefix":"10.1161","volume":"56","author":[{"given":"Nicholas G.","family":"Ferrone","sequence":"first","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."},{"name":"Institute of Health System Science at the Feinstein Institutes for Medical Research, Manhasset, NY (N.G.F., S.R.F., P.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7227-8827","authenticated-orcid":true,"given":"Maria X.","family":"Sanmartin","sequence":"additional","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."},{"name":"Department of Radiology (M.X.S., J.J.W., J.M.K., P.C.S.) at Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8710-128X","authenticated-orcid":true,"given":"Joseph","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia R.","family":"Ferrone","sequence":"additional","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."},{"name":"Institute of Health System Science at the Feinstein Institutes for Medical Research, Manhasset, NY (N.G.F., S.R.F., P.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6211-2572","authenticated-orcid":true,"given":"Jason J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."},{"name":"Department of Radiology (M.X.S., J.J.W., J.M.K., P.C.S.) at Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8193-3683","authenticated-orcid":true,"given":"Jeffrey M.","family":"Katz","sequence":"additional","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."},{"name":"Department of Radiology (M.X.S., J.J.W., J.M.K., P.C.S.) at Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY."},{"name":"Department of Neurology (J.M.K.) at Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9633-3699","authenticated-orcid":true,"given":"Pina C.","family":"Sanelli","sequence":"additional","affiliation":[{"name":"Northwell Health, New Hyde Park, NY (N.G.F., M.X.S., J.O.H., S.R.F., J.J.W., J.M.K., P.C.S.)."},{"name":"Institute of Health System Science at the Feinstein Institutes for Medical Research, Manhasset, NY (N.G.F., S.R.F., P.C.S.)."},{"name":"Department of Radiology (M.X.S., J.J.W., J.M.K., P.C.S.) at Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107914"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.036701"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106035"},{"key":"e_1_3_3_8_2","unstructured":"Stroke Awareness Foundation. Stroke Facts & Statistics. September 14 2023. Accessed September 14 2023. https:\/\/www.strokeinfo.org\/stroke-facts-statistics\/"},{"key":"e_1_3_3_9_2","unstructured":"American Stroke Association. 5 Key Facts About Stroke. https:\/\/www.stroke.org\/en\/professionals\/stroke-resource-library\/"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000074"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012943"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207764"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2019-136413"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318203e952"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.881490"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5340"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2021.07.027"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030105"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106315"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/8653396"},{"key":"e_1_3_3_22_2","unstructured":"National Institutes of Health. NIH policy on reporting race and ethnicity data: subjects in clinical research. Notice: NOT-OD-01-053. August 8 2001. Accessed September 17 2023. https:\/\/grants.nih.gov\/grants\/guide\/notice-files\/NOT-OD-01-053.html"},{"key":"e_1_3_3_23_2","unstructured":"United States Census Bureau. American Community Survey: B19013 Median Household Income. 2022. Accessed September 17 2023. https:\/\/data.census.gov\/all?q=2022"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030427"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003331"},{"key":"e_1_3_3_26_2","first-page":"83","article-title":"Mode of arrival to the emergency department of stroke patients in the United States.","volume":"1","author":"Mohammad YM","year":"2008","unstructured":"Mohammad YM. Mode of arrival to the emergency department of stroke patients in the United States. J Vasc Interv Neurol. 2008;1:83\u201386.","journal-title":"J Vasc Interv Neurol"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.32.1.63"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002099"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e318284056a"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMms2025396"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1524839910369202"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.000017"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000089"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.5202"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2011.11.6820"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06738-0"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101525"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1161\/svin.122.000519"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000437"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.31.8.1925"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.008502"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2021.1954271"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.2147\/oaem.s427945"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.124.049169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T17:11:41Z","timestamp":1758561101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.124.049169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1161\/STROKEAHA.124.049169"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.124.049169","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-08","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}