Zixiao Li1, Jeyaraj Pandian1, P N Sylaja1, Yilong Wang1, Xingquan Zhao1, Liping Liu1, Chunjuan Wang1, Dheeraj Khurana1, M V Padma Srivastava1, Subhash Kaul1, Deepti Arora1, Lee H Schwamm1, Yongjun Wang1, Aneesh B Singhal2. 1. 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. 2. 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. asinghal@partners.org yongjunwang1962@gmail.com.
Abstract
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 p < 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.
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 p < 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.
Authors: Haiqiang Jin; Sainan Zhu; Jade W Wei; Jiguang Wang; Ming Liu; Yangfeng Wu; Lawrence K S Wong; Yan Cheng; En Xu; Qidong Yang; Craig S Anderson; Yining Huang Journal: Stroke Date: 2012-01-12 Impact factor: 7.914
Authors: Lee H Schwamm; Gregg C Fonarow; Mathew J Reeves; Wenqin Pan; Michael R Frankel; Eric E Smith; Gray Ellrodt; Christopher P Cannon; Li Liang; Eric Peterson; Kenneth A Labresh Journal: Circulation Date: 2008-12-15 Impact factor: 29.690
Authors: P N Sylaja; Jeyaraj Durai Pandian; Subhash Kaul; M V Padma Srivastava; Dheeraj Khurana; Lee H Schwamm; Praveen Kesav; Deepti Arora; Aman Pannu; Tijy K Thankachan; Aneesh B Singhal Journal: Stroke Date: 2017-11-22 Impact factor: 7.914
Authors: A Malmivaara; A Meretoja; M Peltola; D Numerato; R Heijink; P Engelfriet; S H Wild; É Belicza; D Bereczki; E Medin; F Goude; G Boncoraglio; T Tatlisumak; T Seppälä; U Häkkinen Journal: Eur J Neurol Date: 2014-09-08 Impact factor: 6.089
Authors: Valery L Feigin; Gregory A Roth; Mohsen Naghavi; Priya Parmar; Rita Krishnamurthi; Sumeet Chugh; George A Mensah; Bo Norrving; Ivy Shiue; Marie Ng; Kara Estep; Kelly Cercy; Christopher J L Murray; Mohammad H Forouzanfar Journal: Lancet Neurol Date: 2016-06-09 Impact factor: 44.182