Journal of Cardiovascular Nursing Vol. 00, No. 0, pp 00Y00 x Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved. Factors Associated With the Hospital Arrival Time in Patients With Ischemic Stroke in Korea Jeongha Sim, PhD, RN; Cha-Nam Shin, PhD, RN; Kyungeh An, PhD, RN; Michael Todd, PhD Background: Stroke is a leading cause of death and disability among the Korean population. Ischemic stroke patients tend to delay arrival at the hospital and often miss the ‘‘golden’’ 3-hour window, which is optimal for tissue plasminogen activator treatment. Objective: The purposes of this study were to compare demographic, clinical/behavioral, and sociocultural characteristics of ischemic stroke patients who reside in urban and rural areas of Korea and to identify factors contributing to the time taken from symptom onset to hospital arrival. Methods: A cross-sectional, descriptive study was conducted using a structured survey in a convenience sample of 229 ischemic stroke patients in Korea. Results: Individuals who resided in rural areas were more likely to be female, older, less educated; had lower incomes; contacted adult children at the onset of stroke; and took a longer time to be transported to a hospital than did those who resided in urban areas (P G .05). Patients who visited an emergency room, transferred via an ambulance, contacted emergency medical services, perceived symptoms as serious, had a family history of stroke, or experienced hemiparesis as the primary stroke symptom arrived at the hospital relatively sooner, whereas patients who experienced unclear symptoms took relatively more time to arrive at the hospital following symptom onset (P G .05). Conclusions: Nationwide efforts are needed to promote public awareness of stroke and to develop strategies to reduce prehospital delay time for ischemic stroke patients, particularly those who reside in rural areas in Korea. KEY WORDS: Korean, stroke, symptoms S troke is a leading cause of mortality and disability in Korea and worldwide. 1Y3 Early hospital arrival is crucial for reperfusion therapy using tissue plas- minogen activator (tPA). 4 Yet the factors associated with hospital arrival time after stroke among Koreans are largely unknown. In this study, we examined associa- tions between hospital arrival time and personal factors (eg, demographic, clinical/behavioral, and sociocultural) and place of residence (urban vs rural areas) in a sample of ischemic stroke patients in Korea. Suggestions for future research and implications for clinical practice are presented. Background An estimated 795 000 Koreans 30 years or older had a stroke diagnosed by physicians in 2012, and approx- imately 27 000 people died of stroke in 2010. 1,5 With increases in the aging population and the prevalence of chronic health conditions associated with stroke (eg, metabolic disorders), the incidence of stroke con- tinues to grow and is projected to increase 3.5-fold by 2030. 6Y8 In particular, the incidence of ischemic stroke among adults (aged 35Y74 years) has increased annually by 7.18%, whereas hemorrhagic stroke decreased by 1.82% each year during the period from 1995 to 2003. 1,9 Once individuals have a stroke, not only do their quality of life and family dynamics suffer, but also fis- cal burdens often fall upon affected individuals, fam- ilies, and society because of lifetime disability after stroke. The nationwide total cost for stroke increased from $3.3 billion in 2005 to $3.94 billion in 2010, with a 54.7% increase in the total cost for admission and out- patient visits for stroke between 2005 and 2009 in Korea. 8,9 1 Jeongha Sim, PhD, RN Assistant Professor, Department of Nursing, Jeonju University, South Korea. Cha-Nam Shin, PhD, RN Assistant Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix. Kyungeh An, PhD, RN Associate Professor, College of Nursing, Virginia Commonwealth University, Richmond. Michael Todd, PhD Associate Research Professor, College of Nursing Health Innovation, Arizona State University, Phoenix. J.S. received a grant from the Basic Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2011-0014173) in 2011. The other authors have no conflicts of interest to disclose. Correspondence Cha-Nam Shin, PhD, RN, 500 N 3rd St, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004 (Cha-Nam.Shin@asu.edu). DOI: 10.1097/JCN.0000000000000313 Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.