Abstract T MP84: Quality of Stroke Care in India: the Indo-US Stroke Project

Background: There is limited information concerning the quality of care and outcomes after stroke in developing countries. We investigated stroke quality in 5 high-volume academic tertiary hospitals across India, using measures derived from the AHA GWTG-Stroke program. Methods: The Indo-US Stroke Registry and Infrastructure Development Project, jointly funded by NINDS and the Indian Dept. of Biotechnology, includes 5 large academic centers in India and one in the US. Trained MD co-investigators and research coordinators prospectively collect data on consecutive adults with imaging-confirmed ischemic stroke <2 weeks after symptom onset. Data is entered into a web-based electronic database. The enrollment goal is 2000 subjects. Results: From November-12 to July-14, we enrolled 1944 patients across the 5 Indian centers. Mean age 58±14y (range 18-92), 67.3% males; median NIHSS 10. IV tPA was given to 11%, including 139/188 patients arriving 0-3 h and 76/98 arriving 3-4.5 hrs after onset; 57(3%) received IA lysis. By the end of Day 2, 91% received antithrombotics and 45% received DVT prophylaxis. Dysphagia screening prior to oral intake was completed in 1438 (75%); 44% failed the screen and 26% remained NPO during hospitalization. In-hospital complications included pneumonia (13%), DVT/PE (2%), and UTI (10%; nearly all had indwelling Foley catheters). Lipid panel obtained in 85% and HemoglobinA1C in 61%. Discharge meds included antiplatelets (90%), anticoagulants (23%), and lipid lowering agents (83%). Of 178 patients with atrial fibrillation, 84% were discharged on anticoagulation. Discharge education included information about stroke risk factors and awareness (93%), emergent evaluation for new symptoms (93%), prescribed medications (93%), smoking cessation (3%). In-hospital mortality was 6.4%; 66% were assessed for rehabilitation but 86% were discharged home. Conclusion: These data provide insights about stroke quality of care in large academic Indian hospitals, and suggest underuse of guideline-based care. Opportunities exist for establishing programs like GWTG-Stroke in India.