Abstract WP289: Comparison of Ischemic Stroke in China versus India: Patient Characteristics, Performance Measures and Outcomes

Abstract

Background: Although major stroke burden occurs in developing countries, there is lack of comparable assessment of patient characteristics, adherence to guideline-recommended performance measures, and outcomes in acute ischemic stroke (AIS). We compared data from Indo-US Stroke Registry (ISR) and China National Stroke Registry-II (CNSR-II). Methods: The ISR prospectively enrolled N=2066 over 2 years across five large academic hospitals in different geographic regions in India. From CNSR-II we selected 31 large academic hospitals mainland provinces in China, where N=1973 were prospectively enrolled over an overlapping 9-month period. In-hospital patient characteristics, adherence to guideline-recommended performance measures, in-hospital mortality, and 3-month outcomes were compared. Results: As compared to ISR, patients in the CNSR-II were significantly older (mean age 63.9 vs. 58.3 years, p=0.001), had less diabetes mellitus and dyslipidemia but more hypertension and atrial fibrillation (AF), and lesser stroke severity (NIHSS median 4 vs. 10, p<0.001). Patients in China were more likely to receive early antithrombotic, dysphagia screening, antiplatelet at discharge, and stroke education, but less likely to receive IV rt-PA, anticoagulation for AF, statin treatment, and antihypertensive medication. Patients in China had lower in-hospital mortality (1.2% versus 7.9%) and better 3-month outcomes (modified Rankin Scale score <2, 78.1% vs. 49.3%, p<0.001). Conclusions: Chinese and Indian populations have a significantly different vascular risk profile. Differences in the care delivery, stroke resources and infrastructure (e.g. Indian hospitals preferably admit more severe strokes and thrombolysed patients), may explain the differences in outcomes. Our results are relevant to tailoring National approaches to acute and in-hospital stroke management in China and India, and may have implications for other developing countries.