Determinants and long-term outcomes of treatment delays in young and middle-aged acute ischemic stroke patients: a prospective cohort study

Treatment delays critically affect outcomes in acute ischemic stroke (AIS). This study investigates predictors of delayed hospital presentation and its long-term impact in young/middle-aged AIS patients. In this prospective longitudinal study, 488 consecutive AIS patients (18–59 years old), admitted to our tertiary hospital (June 2021-February 2024), based on the onset-to-needle time for intravenous thrombolysis (IVT) ≤ 4.5 h or the onset-to-groin puncture time for endovascular thrombectomy (EVT) ≤ 24 h for inclusion in a timely-treatment group and other patients in a delayed-treatment group. Multimodal assessments included socioeconomic surveys, NIHSS scores, and followed up with modified Rankin Scale (mRS) and Stroke-Specific Quality of Life Scale (SS-QOL) at 1 and 6 months after onset. Multivariable logistic regression identified delay predictors. Among 488 eligible patients (mean age 52.07 ± 6.68 years), 448 (91.8%) experienced treatment delays. Lower monthly income (OR = 3.76, 95%CI = 1.10–4.48), extended hospital distance (OR = 2.86, 95%CI = 1.31–6.24), and illness during non-working hours (OR = 5.85, 95%CI = 2.39–14.36). first visit medical facility is a non-three level hospital(OR = 3.87, 95%CI = 1.47–10.16), non-emergency admission (OR = 27.99, 95%CI = 3.55-220.86), and higher NIHSS score (OR = 0.81, 95%CI = 0.74–0.90) were associated with treatment delay. The negative impact of treatment delay on patient prognosis and quality of life shows a strengthening trend over time. Delayed presentation correlated with poorer 6-month outcomes: higher mRS scores (β = 0.41, P < 0.05) and reduced SS-QOL (ρ=-0.38, P < 0.05). Over 90% of young/middle-aged AIS patients experience treatment delays driven by socioeconomic barriers (low income, geographic constraints) and atypical symptom profiles. The negative impact of treatment delay on prognosis and quality of life strengthens over time. These findings advocate for targeted public health interventions addressing financial/geographic disparities and enhancing recognition of subtle stroke manifestations in the younger populations.