Neurology 2018 10 29;91(14):e1348-e1354. Epub 2018 Aug 29.
From Vascular Neurology (Z.L., X.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Yilong Wang, C.W.), and Neuro-Intensive Care Unit (L.L.), Department of Neurology, Beijing TianTan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Z.L., Yilong Wang, X.Z., L.L., C.W., Yongjun Wang), Beijing; Department of Neurology (J.P., D.A.), Christian Medical College and Hospital, Ludhiana; Department of Neurology (P.N.S.), SreeChitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India; Center of Stroke (Yilong Wang, X.Z., C.W., Yongjun Wang), Beijing Institute for Brain Disorders, China; Department of Neurology (D.K.), Postgraduate Institute of Medical Education and Research, Chandigarh; Department of Neurology (M.V.P.S.), All-India Institutes of Medical Sciences, New Delhi; Department of Neurology (S.K.), Nizam's Institute of Medical Sciences, Hyderabad, India; and Department of Neurology (L.H.S., A.B.S.), Massachusetts General Hospital, Boston.
Objective: To understand stroke risk factors, status of stroke care, and opportunities for improvement as China and India develop national strategies to address their disproportionate and growing burden of stroke.
Methods: We compared stroke risk factors, acute management, adherence to quality performance measures, and clinical outcomes among hospitalized ischemic stroke patients using data from the Indo-US Collaborative Stroke Project (IUCSP) and China National Stroke Registry-II (CNSR-II). The IUCSP included 5 academic stroke centers from different geographic regions (n = 2,066). For comparison, the CNSR-II dataset was restricted to 31 academic hospitals among 219 participating sites from 31 provinces (n = 1,973).
Results: Indian patients were significantly younger, had health insurance less often, and had significantly different risk factors (more often diabetes mellitus, dyslipidemia, and coronary heart disease; less often prior stroke, hypertension, atrial fibrillation, and smoking). Hospitalized Indian patients had greater stroke severity (median NIH Stroke Scale score 10 vs 4), higher rates of IV thrombolysis within 3 hours (7.5% vs 2.4%), greater in-hospital mortality (7.9% vs 1.2%), and worse outcome (3-month modified Rankin Scale score 0-2, 49.3% vs 78.1%) (all < 0.001). The poorer clinical outcomes were attributable mainly to greater stroke severity in IUCSP patients. Chinese patients more often received antithrombotics, stroke education, and dysphagia screening during hospitalization.
Conclusion: These data provide insights into the status of ischemic stroke care in academic urban centers within 2 large Asian countries. Further research is needed to determine whether these patterns are representative of care across the countries, to explain differences in observed severity, and to drive improvements.