Abstract 17: Ischemic Stroke Profile, Risk Factors and Outcomes in India: The Indo-US Stroke Project
Background: There is limited data about ischemic stroke in India. We characterized the clinical profile, risk factors and predictors of outcome after stroke in the Indian population, and investigated regional variations.
Methods: The Indo-US Stroke Registry and Infrastructure Development Project, jointly funded by NINDS and the Indian Department of Biotechnology, currently includes 5 geographically diverse centers in North and South India and one in Boston, USA. Trained MD co-investigators and research coordinators prospectively collect data on consecutive adult patients with imaging-confirmed ischemic stroke <2 weeks after symptom onset. Data is entered into a central web-based electronic database.
Results: From Nov-2012 to Jun-2013, 967 patients were enrolled. Mean age 59.7±13.9 yrs (range 20-92), 66% males. The patient population was 65% Hindu, 21% Sikh, 7% Christian, 6% Muslim, and 0.3% Jain; 58% had government health insurance. Only 3% arrived via EMS. Stroke risk factors included hypertension (66%), diabetes (39%), hyperlipidemia (20%), CAD (16%), atrial fibrillation (7.4%, rheumatic heart disease (5%). In addition to cigarette smoking (20%), exposure to beedi, hukkah, and smokeless tobacco (paan) was common (13%). The median admission NIHSS score was 9 (IQR, 5-15). Stroke subtypes using the automated ‘Causative Classification of Stroke’ program were large-artery atherosclerosis 31%, cardio-embolism 24%, small-vessel disease 15%, other defined causes 6%, and undetermined 24%. There were several regional differences, eg. hyperlipidemia, North 5% vs South 42% (p<0.001), good outcome (discharge mRS 0-2), North 45% vs South 57, p<0.001). Multivariate logistic regression analysis adjusting for age, gender and stroke severity showed that large artery atherosclerosis (OR 2.24, CI 2.18-2.37, p=0.02) and MCA territory strokes (OR 3.48, CI 2.02-3.67, p<0.0001) were predictors of poor outcome (mRS 3-6).
Conclusions: The data provide insights about stroke in a large developing country. Resources are needed to address risk factors, regional differences, and develop the infrastructure for stroke care in India.
Author Disclosures: P. Sylaja: None. J. Pandian: None. S. Kaul: None. D. Khurana: None. P. Srivastava: None. T. Thankachan: None. D. Arora: None. P. Titus: None. A. Singhal: None.
- © 2014 by American Heart Association, Inc.