Amar Dhand

Approximately 70 percent of U.S. stroke patients each year will arrive at the hospital more than six hours after the onset of symptoms. While in many cases novel treatment strategies can prevent the worst consequences of a stroke, delays in seeking care can put these therapies out of reach. 

Brigham investigators recently examined how social circles, or “networks,” may influence delays in arrival times for patients experiencing stroke symptoms. The team found that patients with closer-knit social circles, including family members and spouses, were more likely to delay seeking hospital care, whereas those with a more dispersed network of acquaintances were more likely to seek care faster. The analysis was published in Nature Communications.

“Closed networks are like echo chambers in which there is a tendency for everyone to agree to watch and wait,” said corresponding author Amar Dhand, MD, DPhil, of the Department of Neurology. “A major problem in stroke care is patients’ delayed arrival to the hospital, and we show that this problem is related to the influence of patients’ social networks.”

Dhand and colleagues surveyed 175 patients within five days of suffering from a stroke. They collected details from each participant and used this information to create maps of personal relationships. The team focused on patients with milder symptoms because this population is at higher risk for delay and could engage in the survey during hospitalization.

The research team discovered that the networks of slow arrivers were smaller and more close-knit than those of fast arrivers, confirming a paradoxical role for a person’s social environment in a medical emergency. The authors concluded that a shift from mass education about stroke symptoms to a more targeted approach may help reduce delays. Identifying at-risk patients with small and close-knit networks before a stroke and teaching them about symptoms, communication pitfalls and how to develop an action plan, which might include calling a designated friend, could improve stroke preparedness and outcomes.

The current study was limited mainly to patients who had experienced a mild stroke and spoke English. The survey did not include those with moderate or severe strokes or aphasia. The study also relied on self-reporting of social networks. The authors note that additional study in more diverse populations is warranted.