Quality of care for ischemic stroke in China vs India

Li, Zixiao; Pandian, Jeyaraj D.; Sylaja, P.N.; Wang, Yilong; Wang, Wenjuan; Liu, Liping; Wang, Chunjuan; Khurana, Dheeraj; Srivastava, M V Padma; Kaul, Subhash; Arora, Deepti; Schwamm, Lee H; Singhal, Aneesh B.

doi:10.1212/wnl.0000000000006291

Cited by 19 publications

(17 citation statements)

References 16 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our finding of lower thrombolysis treatment rates for AIS patients in China and India/Sri Lanka, compared to Australian/UK patients, is consistent with Asian registries [32,33]. Underlying barriers for thrombolysis in Asia include delayed presentation from the onset of symptoms, concerns over harm, inexperience, and high cost of thrombolysis treatment when there is no health insurance coverage [31,34,35]. Although ASU care is defined as multidisciplinary and a Level I guideline recommendation, early rehabilitation is less common in China and India/Sri Lanka, and many other resource settings in LMICs, in part due to limited availability of allied healthcare professionals and ethnic/cultural differences in the understanding of 'passive' and 'active' rehabilitation [11,33,36,37].…”

Section: Discussionsupporting

confidence: 84%

“…However, some of this variation may reflect differences in definitions, concepts and approaches to monitoring; for example, use of neuro-intensive care and neurosurgery for stroke patients is high in China [26,27], and interdisciplinary vascular units, which combine stroke with cardiac care, are popular in Brazil [28,29]. As shown in various national registries in China and India [30][31][32], the patients who are more likely to receive ASU care are those who are old, have AIS, greater neurological severity and more vascular risk factors.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

Ouyang

Zhang

Wang

et al. 2020

Journal of the Neurological Sciences

View full text Add to dashboard Cite

Access to acute stroke unit (ASU) care is known to vary worldwide. We aimed to quantify regional variations in the various components of ASU care. Method: Secondary analysis of the Head Positioning in acute Stroke Trial (HeadPoST), an international, multicentre, cluster crossover trial of head-up versus head-down positioning in 11,093 acute stroke patients at 114 hospitals in 9 countries. Patients characteristics and 11 standard components of processes of care were described according to ASU admission within and across four economically-defined regional groups (Australia/UK, China [includes Taiwan], India/Sri Lanka, and South America [Brazil/Chile/Colombia]). Variations in process of ASU care estimates were obtained in hierarchical mixed models, with adjustment for study design and potential patient-and hospital-level confounders. Results: Of 11,086 patients included in analyses, 59.7% (n = 6620) had an ASU admission. In China, India/Sri Lanka and South America, ASU patients were older, had greater neurological severity and more premorbid conditions than non-ASU patients. ASU patients were more likely to receive reperfusion therapy and multidisciplinary care within regions, but the components of care varied across regions. With Australia/UK as reference, patients in other regions had a lower probability of receiving reperfusion therapy, especially in India/Sri Lanka (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.12-0.63) and multidisciplinary care (mainly in formal dysphagia assessment, physiotherapy and occupational therapy). Conclusion:There is significant variation in the components of stroke care across economically-defined regions of the world. Ongoing efforts are required to reduce disparities and optimise health outcomes, especially in resource poor areas. Clinical trial registration: HeadPoST is registered at ClinicalTrials.gov (NCT02162017).

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

Ouyang

Zhang

Wang

et al. 2020

Journal of the Neurological Sciences

View full text Add to dashboard Cite

show abstract

“…As a predominant stroke subtype, ischemic stroke constituted 69.6% among all subtypes of incident stroke according to the national epidemiological survey of stroke in China [2]. At present, intravenous recombinant tissue plasminogen activator and endovascular mechanical thrombectomy are effective at the hyperacute phase, but they are hampered by the narrow time window and strict indications [3,4]. Patients who fail to receive these managements may be left with a residual deficit.…”

Section: Introductionmentioning

confidence: 99%

Stem cell-based therapies for ischemic stroke: a systematic review and meta-analysis of clinical trials

Dong

Tian

et al. 2020

Stem Cell Res Ther

View full text Add to dashboard Cite

Recently, extensive researches about stem cell-based therapies for ischemic stroke have been published; our review evaluated the efficacy and safety of stem cell-based therapies for ischemic stroke. Our review was registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number CRD42019135805. Two independent observers searched PubMed, EMBASE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), and Web of Science (Science Citation Index Expanded) for relevant studies up to 31 May 2019. We included clinical trials which compared efficacy outcomes (measured by National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), or Barthel index (BI)) and safety outcomes (such as death and adverse effects) between the stem cell-based therapies and control in ischemic stroke. We performed random effect meta-analysis using Review Manager 5.3. Our review included nine randomized controlled trials (RCTs) and seven non-randomized studies (NRSs), involving 740 participants. Stem cell-based therapies were associated with better outcomes measured by NIHSS (mean difference (MD) − 1.63, 95% confidence intervals (CI) − 2.73 to − 0.53, I 2 =60%) and BI (MD 14.68, 95% CI 1.12 to 28.24, I 2 = 68%) in RCTs, and by BI (MD 6.40, 95% CI 3.14 to 9.65, I 2 = 0%) in NRSs. However, the risk of bias was high and the efficacy outcomes of RCTs were high heterogeneity. There was no significant difference in mortality between the stem cell group and the control group. Fever, headache, and recurrent stroke were the most frequently reported adverse effects. Our review shows that stem cell-based therapies can improve the neurological deficits and activities of daily living in patients with ischemic stroke.

show abstract

“…Except for smoking cessation, the other six measurements are identical to the American Heart Association—Get With The Guideline (AHA-GWTG) measurements ( 32 ). We also included stroke education, which would be provided to patients or caregivers as a measurement concerning weight loss, dietary modification, physical activity, and smoking cessation advisement ( 33 ).…”

Section: Methodsmentioning

confidence: 99%

Concurrency of Early-Age Exposure to Chinese Famine and Diabetes Increases Recurrence of Ischemic Stroke

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and Purpose: Early age exposure to the Chinese Great Leap Forward famine (1959–1961) is associated with the incidence of risk factors for ischemic stroke. This study aims to examine the relationship between early age famine exposure and 12-month stroke recurrence. We sought to explore the interaction between famine exposure status and metabolic phenotypes on stroke recurrence and how the adherence of crucial evidence-based key performance indicators (KPI) would modify this interaction.Methods: We analyzed data of patients who were born between 1953 and 1964 in the China National Stroke Registry II (CNSR-II). The study population was further divided into five subgroups for comparing 12-month stroke recurrence. A multivariate Cox proportional hazard regression model was used in analyzing the impact of the concurrence of metabolic phenotypes—type 2 diabetes (T2D) or metabolic syndrome (MetS)—and early-age famine exposure on recurrent risk. The influence of the adherence to predefined KPI and concurrency of metabolic phenotype was also evaluated.Results: Concurrent T2D and early age famine exposure was associated with an increased recurrence risk of ischemic stroke with 12 months [adjusted hazard ratio (HR): 1.63, 95% confidence interval (CI) 1.28–2.07]. Optimal adherence to KPI was not associated with significantly reduced risk of 12-month stroke recurrence (adjusted HR: 0.80, 95% CI: 0.51–1.26).Conclusions: Concurrency of early-age famine exposure and diabetes mellitus was associated with a higher risk of stroke recurrence within 12 months, and adherence to evidence-based KPI did not reduce the risk significantly.

show abstract

Quality of care for ischemic stroke in China vs India

Cited by 19 publications

References 16 publications

Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study

Stem cell-based therapies for ischemic stroke: a systematic review and meta-analysis of clinical trials

Concurrency of Early-Age Exposure to Chinese Famine and Diabetes Increases Recurrence of Ischemic Stroke

Contact Info

Product

Resources

About