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

• Published in: The Lancet (British edition) 2018-05, Vol.391 (10134), p.2019-2027
• Main Authors: Zhang, Hongye, Lopez-Jaramillo, Patricio, Hankey, Graeme J, Lisheng, Liu, Diener, Hans-Christoph, Pogosova, Nana, Iqbal, Romana, Oguz, Aytekin, Ogunniyi, Adesola, Malaga, German, McQueen, M., Hall, K., Wang, X., Gupta, R., Rodriguez, M.A., Duran, R.G., Nofal, P.G., Desmery, P.M., Varigos, J., Pereira, M.P., Teixeira, M., Carvalho, A., Gebara, O., Hernandez, M.E., Mota, D.M., Shuaib, A., Carcamo, D., Fang, H.P., Lian, M.F., Shen, F., Liu, Z.Z., Zhang, C.S., Wang, H.L., Chen, Y., Wang, L.J., Liu, H.F., Zhao, J.G., Wang, X.Y., Sanchez-Vallejo, G., Garcia Lozada, H., Pedersen, M.M., Back, T., Sigamani, A., Mathur, N., Rahul, P., Roy, A.K., Salam, K.A., Achambat, L., Chidambaram, N., Babu, G.K., Sarada, G., Navya Vani, S., Wadia, R.S., Joshi, S., Pandharipande, M., Joshi, R., Kalantri, S.P., Singh, R., Pagare, S., Mahanta, T.G., Devendrappa, H.R., Jain, V., Akhavan, H., Ibrahim, Z., Husin, A., Loureiro, S., Owolabi, M.O., Wasay, M., Loza-Herrera, J.D., Dans, A., Collantes, E., Morales, D., Roxas, A., Chwojnicki, K., Karpova, A., Al-Hussain, F., Magazi, D., Sawaraldahab, Z., Abdelhameed, A., Alsir, H., Andreasson, M., Cederin, B., Paryoonwiwat, N., Suwanwela, N.C., Tulyapornchote, R., Pleumpanupat, P., Oguz, A., Akalin, A.A., Balkuv, E., Tireli, H., Cabalar, M., Mondo, C., Kayima, J., Langhorne, P., Muir, K., Johnston, S., Murphy, P., Dutta, D., Mcfarlane, C., McBurnie, K.
• Format: Article
• Language: English
• Subjects: Aged; Cardiac and Cardiovascular Systems; Case-Control Studies; Clinical Medicine; Clinical outcomes; Clustering; Comorbidity; Data collection; Dependence; Developed Countries; Developing Countries; Economic conditions; Economics; Evidence-Based Medicine; Fatalities; Female; global burden; Health care; Health Care Service and Management, Health Policy and Services and Health Economy; Health Services Accessibility; Hemorrhage; High income; Hospitals; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Income; income countries; Kardiologi; Klinisk medicin; Low income groups; Male; management; Middle Aged; Mortality; Observational studies; Patient Outcome Assessment; Patients; Physicians; Poverty; Practice Patterns; Practice Patterns, Physicians; quality; register; Regression analysis; Rehabilitation; riks-stroke; risk-factors; Service facilities; Stroke; Stroke - therapy; Surveys and Questionnaires; Survival; Survival Analysis; therapy; transient ischemic attack; Treatment Outcome; unit care
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(18)30802-X

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. 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. 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