It is unclear if stroke occurring after cardiac procedures is more severe than stroke associated with cardiac conditions without procedures. We compared in-hospital acute ischemic stroke patients admitted with a cardiac diagnosis who did versus did not undergo cardiac procedures.

In this retrospective cohort study, we analyzed adults with in-hospital stroke admitted with a primary cardiac diagnosis in Alberta (2018–2022). Patients were categorized into no prior cardiac procedure, cardiac procedure, or cardiac surgery within 30 days of stroke diagnosis. Multivariable logistic regression was used to assess associations between exposure groups and outcomes.

Among 499 patients (median age 70 years IQR [62–77], 36.7% women), 116 (23.2%) underwent a cardiac procedure, and 227 (45.5%) underwent cardiac surgery prior to stroke diagnosis. Median time from procedure to stroke diagnosis was 1.75 days (IQR 0.87–3.83). In-hospital mortality was 34.6%, 24.1% and 22.5% in patients with no prior procedure, cardiac procedures and cardiac surgery, respectively. After adjustment for age, sex, facility level and comorbidities, no significant differences were observed in mortality (cardiac procedure vs no procedure: aOR 0.73, 95% confidence interval (CI) 0.40–1.33; cardiac surgery vs no procedure: aOR 0.78, 95% CI 0.42–1.45). Among procedural patients, strokes recognized ≥2 days post-procedure were associated with higher mortality (2–7 days: OR 2.31, [1.18–4.52]; 8–30 days: OR 3.23, [1.59–6.59]).

Adjusted mortality did not differ by cardiac procedural status, although residual confounding is possible. Later stroke recognition after cardiac procedures was associated with higher mortality, identifying a high-risk monitoring window.

Patients with stroke while hospitalized experience important delays in symptom recognition. This study aims to describe the overall management of an in-hospital stroke population and how it compares with an out-of-hospital community-onset stroke population.

In this retrospective observational study, we included consecutive patients with in-hospital and out-of-hospital strokes (both ischemic and hemorrhagic) over a period of one year treated at a comprehensive stroke center. Demographic and clinical data were extracted, and patient groups were compared with regard to stroke treatment time metrics.

A total of 362 patients diagnosed with acute stroke were included, of whom 38 (10.5%) had in-hospital and 324 (89.5%) had out-of-hospital strokes. The median delay to stroke recognition (time between the last time seen well and first time seen symptomatic) was significantly longer in in-hospital compared to out-of-hospital strokes (77.5 [0–334.8] vs. 0 [0–138.5] min, p = 0.04). The median time interval from stroke code activation to the arrival of the stroke team at the bedside was significantly shorter in in-hospital versus out-of-hospital cases (10 [6–15] vs. 15 [8–24.8] min, p = 0.01). In-hospital strokes were less likely to receive thrombolysis (12.8% vs. 45.4%, p < 0.01) with significantly higher mortality (18.2% versus 2.6%, p < 0.01) and longer overall median hospital stay (3 [1–7] vs. 12 days [7–23], p < 0.01) compared to out-of-hospital strokes.

This study showed significant delays in stroke symptom recognition and stroke code activation for in-hospital stroke patients despite comparable overall stroke time metrics. Development of in-hospital stroke protocols and systematic staff training on stroke symptom recognition should be implemented to improve care for hospitalized patients.