Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study

Published on May 1, 2018in The Lancet59.10
· DOI :10.1016/S0140-6736(18)30802-X
Peter Langhorne65
Estimated H-index: 65
(Glas.: University of Glasgow),
Martin O'Donnell50
Estimated H-index: 50
(National University of Ireland, Galway)
+ 370 AuthorsK. McBurnie1
Estimated H-index: 1
Summary Background Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. Methods We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. Findings We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p Interpretation Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes. Funding Chest, Heart and Stroke Scotland.
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Published on Aug 1, 2016in Lancet Neurology28.75
Valery L. Feigin70
Estimated H-index: 70
(AUT: Auckland University of Technology),
Gregory A. Roth50
Estimated H-index: 50
(UW: University of Washington)
+ 11 AuthorsMarie Ng27
Estimated H-index: 27
(UW: University of Washington)
Summary Background The contribution of modifiable risk factors to the increasing global and regional burden of stroke is unclear, but knowledge about this contribution is crucial for informing stroke prevention strategies. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the population-attributable fraction (PAF) of stroke-related disability-adjusted life-years (DALYs) associated with potentially modifiable environmental, occupational, behavioural, physiological, ...
Published on Aug 1, 2016in The Lancet59.10
Martin O'Donnell50
Estimated H-index: 50
(National University of Ireland, Galway),
Siu Lim Chin3
Estimated H-index: 3
(Population Health Research Institute)
+ 43 AuthorsSteven Agapay1
Estimated H-index: 1
(Population Health Research Institute)
Summary Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute firs...
Published on Jul 1, 2016in The Lancet59.10
Peter M. Rothwell106
Estimated H-index: 106
(University of Oxford),
Ale Algra72
Estimated H-index: 72
(UU: Utrecht University)
+ 3 AuthorsZiyah Mehta35
Estimated H-index: 35
(University of Oxford)
Summary Background Aspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, the risk of major stroke is very high for only the first few days after TIA and minor ischaemic stroke, and observational studies show substantially greater benefits of early medical treatment in the acute phase than do longer-term trials. We hypothesised that the short-term ben...
Published on Apr 18, 2016in BMJ27.60
Filipe B. Rodrigues11
Estimated H-index: 11
(University of Lisbon),
Joana Briosa Neves4
Estimated H-index: 4
+ 3 AuthorsJoão Costa31
Estimated H-index: 31
Objectives To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. Eligibility criteria for selecting studies Randomised controlled trials in ...
Published on Jan 1, 2016in International Journal of Stroke4.47
Dominique A Cadilhac25
Estimated H-index: 25
(Monash University, Clayton campus),
Joosup Kim7
Estimated H-index: 7
(Monash University, Clayton campus)
+ 5 AuthorsAtte Meretoja45
Estimated H-index: 45
(Florey Institute of Neuroscience and Mental Health)
BackgroundRoutine monitoring of the quality of stroke care is becoming increasingly important since patient outcomes could be improved with better access to proven treatments. It remains unclear how many countries have established a national registry for monitoring stroke care.AimsTo describe the current status of national, hospital-based stroke registries that have a focus on monitoring access to evidence-based care and patient outcomes and to summarize the main features of these registries.Sum...
Published on Apr 1, 2015in Stroke6.05
Melanie Turner6
Estimated H-index: 6
Mark Barber14
Estimated H-index: 14
+ 4 AuthorsMary Joan MacLeod13
Estimated H-index: 13
Background and Purpose—Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes. Methods—Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on...
Published on Jan 1, 2015in Journal of Neurology4.20
Emma Tallantyre7
Estimated H-index: 7
(University Hospital of Wales),
Neil Robertson51
Estimated H-index: 51
(Cardiff University)
Stroke disease is the second leading cause of death in the world. Even if stroke incidence remains stable, the number of new acute strokes in Europe is projected to increase markedly by 2025. In 2007, the SITS-MOST trial provided the first conclusive evidence that intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) was beneficial in the acute period for patients with cerebral infarct. Evidence from the same year showed that decompressive hemicraniectomy can double the r...
Published on Aug 28, 2014in The New England Journal of Medicine70.67
Abstr Act85
Estimated H-index: 85
(Population Health Research Institute),
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(Population Health Research Institute)
+ 37 AuthorsF. Lu1
Estimated H-index: 1
The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 personyears vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were al...
Published on Oct 1, 2013in Journal of Stroke & Cerebrovascular Diseases1.65
Jiménez-Caballero Pe8
Estimated H-index: 8
Fidel López-Espuela4
Estimated H-index: 4
+ 3 AuthorsIgnacio Casado-Naranjo8
Estimated H-index: 8
Background The Charlson Comorbidity Index (CCI) is commonly used in outcome and mortality studies. Our aim was to investigate the association between CCI score and the functional outcome and mortality 6 months after ischemic stroke (IS) or intracerebral hemorrhage. Methods This was a prospective observational cohort of patients with spontaneous intracerebral hemorrhage and IS admitted to the stroke unit during 18 months. The modified Rankin scale (mRS) score was obtained for subjects 6 months af...
Published on Apr 1, 2012in Lancet Neurology28.75
Peter Langhorne65
Estimated H-index: 65
(Glasgow Royal Infirmary),
Linda de Villiers6
Estimated H-index: 6
(UCT: University of Cape Town),
Jeyaraj Durai Pandian34
Estimated H-index: 34
Summary Stroke units have become established as the central component of modern stroke services. However, most stroke-unit trials and service developments have been done in high-income countries, which raises the question of whether such care is relevant and applicable to low-income and middle-income settings. To address this question, we first need to show that stroke units are likely to provide important health gains to populations. Second, we need to identify those components of stroke units ...
Cited By6
Published on Sep 8, 2019in Translational Stroke Research
Ying Shen2
Estimated H-index: 2
(Capital Medical University),
Bao-Hua Chao + 2 AuthorsLongde Wang2
Estimated H-index: 2
(PKU: Peking University)
The aim of this study was to assess the association between admission to stroke centers for acute ischemic stroke and complications and mortality during hospitalization in a Chinese population by means of an observational study using data from the China Stroke Center Data-Sharing Platform. We compared in-hospital complications and mortality for patients admitted with acute ischemic stroke (N = 13,236) between November 1, 2018 and December 31, 2018 at stroke center (SH) and non-stroke center (CH)...
Published on Aug 18, 2019in Topics in Stroke Rehabilitation1.96
Elsje Scheffler5
Estimated H-index: 5
(Stellenbosch University),
Robert Mash13
Estimated H-index: 13
(Stellenbosch University)
Published on 2019in European Journal of Heart Failure13.96
Jasper Tromp8
Estimated H-index: 8
(NUS: National University of Singapore),
João Pedro Ferreira12
Estimated H-index: 12
(University of Lorraine)
+ 4 AuthorsCarolyn S.P. Lam44
Estimated H-index: 44
Published on Jan 1, 2019in Frontiers in Neurology2.63
Cissé Af3
Estimated H-index: 3
charlotte damien (Free University of Brussels)+ 6 AuthorsGilles Naeije (Free University of Brussels)
Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venou...
Published on 2019in Developmental Neurorehabilitation1.24
Clara Chavez Arana (UNAM: National Autonomous University of Mexico), Cathy Catroppa42
Estimated H-index: 42
(University of Melbourne)
+ 6 AuthorsV. Anderson1
Estimated H-index: 1
(UNAM: National Autonomous University of Mexico)
ABSTRACTChildren with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce...
Published on Jul 2, 2019in Journal of the American Heart Association4.66
Paula Muñoz Venturelli3
Estimated H-index: 3
Xian Li10
Estimated H-index: 10
(The George Institute for Global Health)
+ 12 AuthorsHisatomi Arima47
Estimated H-index: 47
Background The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke (AIS) and clinical outcome of pa...
Published on Apr 1, 2019in Lancet Neurology28.75
Simiao Wu1
Estimated H-index: 1
(Sichuan University),
Bo Wu18
Estimated H-index: 18
(Sichuan University)
+ 48 AuthorsYongjun Wang1
Estimated H-index: 1
(Capital Medical University)
Summary With over 2 million new cases annually, stroke is associated with the highest disability-adjusted life-years lost of any disease in China. The burden is expected to increase further as a result of population ageing, an ongoing high prevalence of risk factors (eg, hypertension), and inadequate management. Despite improved access to overall health services, the availability of specialist stroke care is variable across the country, and especially uneven in rural areas. In-hospital outcomes ...
Published on Mar 1, 2019in European Journal of Internal Medicine3.66
Domenico Scrutinio12
Estimated H-index: 12
Domenico Scrutinio15
Estimated H-index: 15
+ 4 AuthorsGianni Giorgi
Abstract Because of the demographic shift and the increased proportion of patients surviving acute critical illnesses, the number of people living with severely disabling chronic diseases and, consequently, the demand for rehabilitation are expected to increase sharply over time. As underscored by the World Health Organization, there is substantial evidence that the provision of inpatient rehabilitation in specialized rehabilitation units to people with complex needs is effective in fostering fu...
Published on Mar 1, 2019in European Heart Journal23.24
Chris P Gale31
Estimated H-index: 31
(University of Leeds),
Barbara Casadei41
Estimated H-index: 41
(BHF: British Heart Foundation)
Published on Feb 1, 2019in Stroke6.05
A. Gabet4
Estimated H-index: 4
Olivier Grimaud5
Estimated H-index: 5
+ 2 AuthorsV. Olié7
Estimated H-index: 7
Background and Purpose— The aims of this study were to (1) describe early and late case fatality rates after stroke in France, (2) evaluate whether their determinants differed, and (3) analyze time...