Mapping Stroke in Regional and Remote Australia: A Scoping Review of Characteristics, Interventions and Outcomes

Abstract

BACKGROUND: Stroke is one of the most common causes of disability and timely treatment is crucial to reduce morbidity and mortality. Regional and remote communities in Australia face a higher incidence of stroke and encounter significant challenges in accessing timely treatment and effective management. OBJECTIVE: The scoping review aimed to analyse existing literature regarding stroke in regional and remote Australia, focusing on patient characteristics, stroke type, interventions, and outcomes. Identifying gaps could trigger future research and highlight what strategies need to be implemented to support this Australian population. METHODS: Arksey and O'Malley's methodological framework and the PRISMA-ScR checklist were used to guide this scoping review. Search dates included 2013 to August 2023, using the Medline (EBSCO), Embase, Scopus, and CINAHL databases. RESULTS: A total of 22 studies were included. The majority of stroke patients were male; participant ages varied, with means ranging from 64 to 74 years and medians from 64 to 78 years, in studies reporting mixed First Nations and non-Indigenous populations. Stroke risk factors were more common in First Nations people, except for atrial fibrillation, which was more prevalent in non-Indigenous people. Reported door-to-needle times for thrombolysis ranged from 77.5 to 100 min. Haemorrhagic strokes were associated with higher mortality. Patients frequently required multiple transfers to access imaging and treatment. Telestroke services were shown to improve care in several regions. However, outer regional and remote patients were less likely to receive thrombolysis, be prescribed stroke prevention medications, or receive care in a stroke unit. CONCLUSIONS: Regional and remote Australians experience significant delays in accessing stroke treatment at a comprehensive stroke centre. Stroke is occurring at much younger ages among First Nations people. Addressing modifiable risk factors and implementing equity-focused strategies, supported by targeted research into regional and remote populations, is essential to reduce the stroke burden in these communities.