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

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; INTERSTROKE collaborators

doi:10.1016/S0140-6736(18)30802-X

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

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 HussainLiu 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, INTERSTROKE collaborators

Department of Clinical Medicine

37 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Lancet Oncology
Volume	391
Issue number	10134
Pages (from-to)	2019-2027
Number of pages	9
ISSN	1470-2045
DOIs	https://doi.org/10.1016/S0140-6736(18)30802-X
Publication status	Published - 1 Jan 2018

Keywords

Aged
Case-Control Studies
Developed Countries
Developing Countries
Evidence-Based Medicine
Female
Health Services Accessibility
Humans
Male
Middle Aged
Patient Outcome Assessment
Poverty
Practice Patterns, Physicians'
Stroke/therapy
Surveys and Questionnaires
Survival Analysis
Treatment Outcome

Access to Document

10.1016/S0140-6736(18)30802-X

Cite this

Langhorne, P., O'Donnell, M. J., Chin, S. L., Zhang, H., Xavier, D., Avezum, A., Mathur, N., Turner, M., MacLeod, M. J., Lopez-Jaramillo, P., Damasceno, A., Hankey, G. J., Dans, A. L., Elsayed, A., Mondo, C., Wasay, M., Czlonkowska, A., Weimar, C., Yusufali, A. H., ... INTERSTROKE collaborators (2018). Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study. Lancet Oncology, 391(10134), 2019-2027. https://doi.org/10.1016/S0140-6736(18)30802-X

Langhorne, P, O'Donnell, MJ, Chin, SL, Zhang, H, Xavier, D, Avezum, A, Mathur, N, Turner, M, MacLeod, MJ, Lopez-Jaramillo, P, Damasceno, A, Hankey, GJ, Dans, AL, Elsayed, A, Mondo, C, Wasay, M, Czlonkowska, A, Weimar, C, Yusufali, AH, Hussain, FA, Lisheng, L, Diener, H-C, Ryglewicz, D, Pogosova, N, Iqbal, R, Diaz, R, Yusoff, K, Oguz, A, Wang, X, Penaherrera, E, Lanas, F, Ogah, OS, Ogunniyi, A, Iversen, HK, Malaga, G, Rumboldt, Z, Magazi, D, Nilanont, Y, Rosengren, A, Oveisgharan, S, Yusuf, S & INTERSTROKE collaborators 2018, 'Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study', Lancet Oncology, vol. 391, no. 10134, pp. 2019-2027. https://doi.org/10.1016/S0140-6736(18)30802-X

@article{b234dd15a048402c87a1df78ae5cab1a,

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

abstract = "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.",

keywords = "Aged, Case-Control Studies, Developed Countries, Developing Countries, Evidence-Based Medicine, Female, Health Services Accessibility, Humans, Male, Middle Aged, Patient Outcome Assessment, Poverty, Practice Patterns, Physicians', Stroke/therapy, Surveys and Questionnaires, Survival Analysis, Treatment Outcome",

author = "Peter Langhorne and O'Donnell, {Martin J} and Chin, {Siu Lim} and Hongye Zhang and Denis Xavier and Alvaro Avezum and Nandini Mathur and Melanie Turner and MacLeod, {Mary Joan} and Patricio Lopez-Jaramillo and Albertino Damasceno and Hankey, {Graeme J} and Dans, {Antonio L} and Ahmed Elsayed and Charles Mondo and Mohammad Wasay and Anna Czlonkowska and Christian Weimar and Yusufali, {Afzal Hussein} and Hussain, {Fawaz Al} and Liu Lisheng and Hans-Christoph Diener and Danuta Ryglewicz and Nana Pogosova and Romana Iqbal and Rafael Diaz and Khalid Yusoff and Aytekin Oguz and Xingyu Wang and Ernesto Penaherrera and Fernando Lanas and Ogah, {Okechukwu S} and Adesola Ogunniyi and Iversen, {Helle K.} and German Malaga and Zvonko Rumboldt and Daliwonga Magazi and Yongchai Nilanont and Annika Rosengren and Shahram Oveisgharan and Salim Yusuf and {INTERSTROKE collaborators}",

year = "2018",

month = jan,

day = "1",

doi = "10.1016/S0140-6736(18)30802-X",

language = "English",

volume = "391",

pages = "2019--2027",

journal = "Lancet Oncology",

issn = "1470-2045",

publisher = "TheLancet Publishing Group",

number = "10134",

}

TY - JOUR

T1 - Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE)

T2 - an international observational study

AU - Langhorne, Peter

AU - O'Donnell, Martin J

AU - Chin, Siu Lim

AU - Zhang, Hongye

AU - Xavier, Denis

AU - Avezum, Alvaro

AU - Mathur, Nandini

AU - Turner, Melanie

AU - MacLeod, Mary Joan

AU - Lopez-Jaramillo, Patricio

AU - Damasceno, Albertino

AU - Hankey, Graeme J

AU - Dans, Antonio L

AU - Elsayed, Ahmed

AU - Mondo, Charles

AU - Wasay, Mohammad

AU - Czlonkowska, Anna

AU - Weimar, Christian

AU - Yusufali, Afzal Hussein

AU - Hussain, Fawaz Al

AU - Lisheng, Liu

AU - Diener, Hans-Christoph

AU - Ryglewicz, Danuta

AU - Pogosova, Nana

AU - Iqbal, Romana

AU - Diaz, Rafael

AU - Yusoff, Khalid

AU - Oguz, Aytekin

AU - Wang, Xingyu

AU - Penaherrera, Ernesto

AU - Lanas, Fernando

AU - Ogah, Okechukwu S

AU - Ogunniyi, Adesola

AU - Iversen, Helle K.

AU - Malaga, German

AU - Rumboldt, Zvonko

AU - Magazi, Daliwonga

AU - Nilanont, Yongchai

AU - Rosengren, Annika

AU - Oveisgharan, Shahram

AU - Yusuf, Salim

AU - INTERSTROKE collaborators

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Aged

KW - Case-Control Studies

KW - Developed Countries

KW - Developing Countries

KW - Evidence-Based Medicine

KW - Female

KW - Health Services Accessibility

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Outcome Assessment

KW - Poverty

KW - Practice Patterns, Physicians'

KW - Stroke/therapy

KW - Surveys and Questionnaires

KW - Survival Analysis

KW - Treatment Outcome

U2 - 10.1016/S0140-6736(18)30802-X

DO - 10.1016/S0140-6736(18)30802-X

M3 - Journal article

C2 - 29864018

SN - 1470-2045

VL - 391

SP - 2019

EP - 2027

JO - Lancet Oncology

JF - Lancet Oncology

IS - 10134

ER -

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

Abstract

Keywords

Access to Document

Fingerprint

Cite this