Have you heard the saying, "It’s all in the timing?" Well, for more than a decade these words have proven to be the rallying cry for victims of strokes, brain attacks suffered by approximately 750,000 people in the U.S. every year. By getting to a hospital and receiving treatment within three, or at the most, six hours after the onset of symptoms, many patients can prevent the serious disability or death caused by too little blood flow to the brain. Yet, "despite national efforts to promote public awareness, more than half of patients with acute stroke failed to arrive at the hospital within the optimal time window (within three hours) for effective intervention," says Clifton R. Lacy, MD, chief of cardiovascular diseases at UMDNJ-Robert Wood Johnson Medical School.

As lead researcher of a study, published in the January 2001 issue of the journal Stroke, Lacy began his project in 1996 at the hospitals of the Robert Wood Johnson Health System in NJ by asking the questions: Do patients still delay in seeking evaluation and treatment for stroke and what are the factors associated with delay? In a stroke, blood supply to the brain is suddenly cut off, killing or damaging brain cells. Warning signs include loss of sensation, weakness or paralysis on one side of the body, fainting and sudden trouble thinking, speaking, seeing or hearing. Stroke is the leading cause of long-term disability and costs the country about $45 billion annually for medical care and lost productivity. Stroke is the third most common cause of death after heart disease and cancer.

Other scientists had documented why timing can be critical in stroke survival and some had examined the impact of patient knowledge. Not recognizing signs of stroke and being unaware of treatments are considerable factors, of course. "Further educational efforts are still needed," the report concludes. However, Lacy’s team wanted to know what else affects delay in seeking care and no conclusive or comprehensive data existed. During a seven month period, the researchers collected information from 553 patients in a wide geographic area and in hospitals ranging in size from 134 to 453 beds.

Delay times may have become shorter in the years since the completion of the research in 1997 and new drugs are being tested which appear to stretch Lacy’s "window of time" beyond current constraints. Even so, the findings answer important questions about this unhealthy waiting game. For instance, two important groups of people are more likely to arrive at a hospital quickly: those over 65 and those with serious heart problems. Older, it seems, is certainly wiser when it comes to understanding the seriousness of stroke symptoms. Gender wasn’t a factor, although women were a little slower to react than men, but black and Hispanic patients waited longer to receive care than whites.

Perhaps the most straight- forward piece in this medical time puzzle was transportation. "Not only were patients who were transported by ambulance brought to the Emergency Department more rapidly but physicians examined them sooner." The urgency in an ambulance ride, with sirens blaring and medical staff on board, offered stroke patients the perfect timing needed to win a deadly battle.