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

Issued Date

2018-01-01

Resource Type

Article

ISSN

1474547X
01406736

DOI

10.1016/S0140-6736(18)30802-X

Other identifier(s)

2-s2.0-85047139566

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet. Vol.391, No.10134 (2018), 2019-2027

Suggested Citation

Peter Langhorne, Martin J. O'Donnell, Siu Lim Chin, Hongye Zhang, Denis Xavier, Alvaro Avezum, Nandini Mathur, Melanie Turner, Mary Joan MacLeod, Patricio Lopez-Jaramillo, Albertino Damasceno, Graeme J. Hankey, Antonio L. Dans, Ahmed Elsayed, Charles Mondo, Mohammad Wasay, Anna Czlonkowska, Christian Weimar, Afzal Hussein Yusufali, Fawaz Al Hussain, Liu Lisheng, Hans Christoph Diener, Danuta Ryglewicz, Nana Pogosova, Romana Iqbal, Rafael Diaz, Khalid Yusoff, Aytekin Oguz, Xingyu Wang, Ernesto Penaherrera, Fernando Lanas, Okechukwu S. Ogah, Adesola Ogunniyi, Helle K. Iversen, German Malaga, Zvonko Rumboldt, Daliwonga Magazi, Yongchai Nilanont, Annika Rosengren, Shahram Oveisgharan, Salim Yusuf, M. O'Donnell, S. Rangarajan, P. Rao-Melacini, X. Michelle Zhang, S. Islam, C. Kabali, A. Casanova, J. DeJesus, M. Dehghan, S. Agapay, M. McQueen, K. Hall, J. Keys, A. Devanath, R. Gupta, D. Prabhakaran, P. Schygiel, M. Garrote, M. A. Rodriguez, A. Caccavo, R. G. Duran, L. Sposato, J. Molinos, P. Valdez, C. M. Cedrolla, P. G. Nofal, M. F. Huerta, P. M. Desmery, M. C. Zurru, B. Della Vedova, J. Varigos, G. Hankey, T. Kraemer, P. Gates, C. Bladin, G. Herkes, M. P. Pereira, L. Minuzzo, L. Oliveira, M. Teixeira, H. Reis, A. Carvalho, S. Ouriques Martins, J. J. Carvalho, O. Gebara, C. Minelli, D. C. Oliveira, A. C. Sobral Sousa, A. C. Ferraz de Almeida, M. E. Hernandez, M. Friedrich, D. M. Mota, L. E. Ritt, D. Correa Vila Nova, P. Teal, D. Gladstone, A. Shuaib, F. Silver, D. Dowlatshahi Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study. The Lancet. Vol.391, No.10134 (2018), 2019-2027. doi:10.1016/S0140-6736(18)30802-X Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/47257

Research Projects

Organizational Units

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Thesis

Title

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

Author(s)

Peter Langhorne
 Martin J. O'Donnell
 Siu Lim Chin
 Hongye Zhang
 Denis Xavier
 Alvaro Avezum
 Nandini Mathur
 Melanie Turner
 Mary Joan MacLeod
 Patricio Lopez-Jaramillo
 Albertino Damasceno
 Graeme J. Hankey
 Antonio L. Dans
 Ahmed Elsayed
 Charles Mondo
 Mohammad Wasay
 Anna Czlonkowska
 Christian Weimar
 Afzal Hussein Yusufali
 Fawaz Al Hussain
 Liu Lisheng
 Hans Christoph Diener
 Danuta Ryglewicz
 Nana Pogosova
 Romana Iqbal
 Rafael Diaz
 Khalid Yusoff
 Aytekin Oguz
 Xingyu Wang
 Ernesto Penaherrera
 Fernando Lanas
 Okechukwu S. Ogah
 Adesola Ogunniyi
 Helle K. Iversen
 German Malaga
 Zvonko Rumboldt
 Daliwonga Magazi
 Yongchai Nilanont
 Annika Rosengren
 Shahram Oveisgharan
 Salim Yusuf
 M. O'Donnell
 S. Rangarajan
 P. Rao-Melacini
 X. Michelle Zhang
 S. Islam
 C. Kabali
 A. Casanova
 J. DeJesus
 M. Dehghan
 S. Agapay
 M. McQueen
 K. Hall
 J. Keys
 A. Devanath
 R. Gupta
 D. Prabhakaran
 P. Schygiel
 M. Garrote
 M. A. Rodriguez
 A. Caccavo
 R. G. Duran
 L. Sposato
 J. Molinos
 P. Valdez
 C. M. Cedrolla
 P. G. Nofal
 M. F. Huerta
 P. M. Desmery
 M. C. Zurru
 B. Della Vedova
 J. Varigos
 G. Hankey
 T. Kraemer
 P. Gates
 C. Bladin
 G. Herkes
 M. P. Pereira
 L. Minuzzo
 L. Oliveira
 M. Teixeira
 H. Reis
 A. Carvalho
 S. Ouriques Martins
 J. J. Carvalho
 O. Gebara
 C. Minelli
 D. C. Oliveira
 A. C. Sobral Sousa
 A. C. Ferraz de Almeida
 M. E. Hernandez
 M. Friedrich
 D. M. Mota
 L. E. Ritt
 D. Correa Vila Nova
 P. Teal
 D. Gladstone
 A. Shuaib
 F. Silver
 D. Dowlatshahi

Other Contributor(s)

Dubai Medical College
 Universidad de Santander
 Federal State Institution National Research Center for Preventive Medicine
 UCSI University
 Population Health Research Institute, Ontario
 Universidade Eduardo Mondlane
 Institute of Psychiatry and Neurology, Warszawa
 Hospital Luis Vernaza
 Mulago Hospital
 University of the Philippines Manila
 Universidad Peruana Cayetano Heredia
 The Aga Khan University Hospital
 University of Western Australia
 Sahlgrenska Universitetssjukhuset
 Københavns Universitet
 Instituto Dante Pazzanese de Cardiologia
 University College Hospital, Ibadan
 University of Limpopo
 University of Aberdeen
 King Saud University
 Universidad de la Frontera
 Faculty of Medicine, Siriraj Hospital, Mahidol University
 National University of Ireland Galway
 Universitäts Klinikum Essen und Medizinische Fakultät
 Sveučilište u Splitu
 St. John's Medical College
 University of Glasgow
 National Center for Cardiovascular Diseases
 İstanbul Medeniyet Üniversitesi
 Rush Alzheimer’s Disease Center
 Estudios Clínicos Latinoamérica
 Alzaeim Alazhari University
 Beijing Hypertension League Institute

Abstract

© 2018 Elsevier Ltd 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<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14–1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12–1·72) irrespective of other patient and service characteristics. 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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/47257

Collections

Scopus 2018