Abstract T MP86: Quality of Stroke Care in India: the Indo-US Stroke Project

Abstract

Background: There is limited information concerning the quality of care and outcomes after stroke in developing countries like India. We investigated stroke quality in 5 high-volume academic tertiary hospitals across India, using quality measures derived from the AHA GWTG-Stroke program. Methods: The Indo-US Stroke Registry and Infrastructure Development Project, jointly funded by NINDS and the Indian Department of Biotechnology, currently has 5 centers in India and one in the US. Trained MD co-investigators and research coordinators prospectively collect data on consecutive adult patients admitted with imaging-confirmed ischemic stroke <2 weeks after symptom onset. Data is entered into a central web-based electronic database. Results: From 11/12 to 6/13, 967 patients were enrolled across the 5 Indian centers. Mean age 59.7±14y (range 20-92), 66% males. Eighty-four (8.7%) arrived within 3h and 50 (5.2%) arrived 3.0-4.5h after onset and proved eligible for thrombolysis; of these, 104 (78%) received IV or IA thrombolysis. NIHSS was documented prospectively in 39%, retrospectively in 41%, and not obtained in 20%. Before the end of Day 2, 91% received antithrombotic therapy and 46% received DVT prophylaxis. Dysphagia screening prior to oral intake was completed in 760 patients (79%), of whom 34% failed the screen and 24% remained NPO during hospitalization. In-hospital complications included pneumonia (16%), DVT/PE (4%), and UTI (14%; nearly all had indwelling Foley catheters). LDL cholesterol was documented in 86%. Discharge medications included antiplatelets (85%), anticoagulants (22%), and lipid lowering agents (76%). Of 105 patients with atrial fibrillation, 59 (44%) were discharged on anticoagulation. Discharge education included information about stroke risk factors and awareness (93%), emergent evaluation for new symptoms (53%), prescribed medications (93%), smoking cessation counseling (13%). In-hospital mortality was 6%, 40% were assessed for rehabilitation but 83.5% were discharged home . Conclusions: These early data provide insights about stroke quality of care in large academic Indian hospitals, and suggest underuse of guideline-based care. Opportunities exist for establishing programs like GWTG-Stroke in India.