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

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dc.contributor.authorLanghorne, Peterspa
dc.contributor.authorO'Donnell, Martin J.spa
dc.contributor.authorLim Chin, Siuspa
dc.contributor.authorZhang, Hongyespa
dc.contributor.authorXavier, Denisspa
dc.contributor.authorAvezum, Alvarospa
dc.contributor.authorMathur, Nandinispa
dc.contributor.authorTurner, Melaniespa
dc.contributor.authorMacLeod, Mary Joanspa
dc.contributor.authorLopez-Jaramillo, Patriciospa
dc.contributor.authorDamasceno, Albertinospa
dc.contributor.authorHankey, Graeme J.spa
dc.contributor.authorDans, Antoniospa
dc.contributor.authorElSayed, Ahmedspa
dc.contributor.authorMondo, Charlesspa
dc.contributor.authorWasay, Mohammadspa
dc.contributor.authorCzlonkowska, Annaspa
dc.contributor.authorWeimar, Christianspa
dc.contributor.authorHussein Yusufali, Afzalspa
dc.contributor.authorAlHussain, Fawazspa
dc.contributor.authorLisheng, Liuspa
dc.contributor.authorDiener, Hans Christophspa
dc.contributor.authorRyglewicz, Danutaspa
dc.contributor.authorPogosova, Nanaspa
dc.contributor.authorIqbal, Romainaspa
dc.contributor.authorDiaz, Rafaelspa
dc.contributor.authorYusoff, Khalidspa
dc.contributor.authorOguz, Aytekinspa
dc.contributor.authorWang, Xingyuspa
dc.contributor.authorPenaherrera, Ernestospa
dc.contributor.authorLanas, Fernandospa
dc.contributor.authorOgah, Okechukwu S.spa
dc.contributor.authorOgunniyi, Adesolaspa
dc.contributor.authorIversen, Helle K.spa
dc.contributor.authorMalaga, Germanspa
dc.contributor.authorRumboldt, Zvonkospa
dc.contributor.authorMagazi, Daliwongaspa
dc.contributor.authorNilanont, Yongchaispa
dc.contributor.authorRosengren, Annikaspa
dc.contributor.authorOveisgharan, Shahramspa
dc.contributor.authorYusuf, Salimspa
dc.contributor.authorOn behalf of the INTERSTROKE collaboratorsspa
dc.date.accessioned2019-07-16T16:59:32Zspa
dc.date.available2019-07-16T16:59:32Zspa
dc.date.issued2018-05spa
dc.description9 p.spa
dc.description.abstractBackground: 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.eng
dc.format.mimetypeapplication/pdfspa
dc.identifier.doi10.1016/S0140-6736(18)30802-Xspa
dc.identifier.issn0140-6736spa
dc.identifier.urihttps://repositorio.udes.edu.co/handle/001/3405spa
dc.language.isoengspa
dc.relation.ispartofThe Lanceteng
dc.rightsDerechos Reservados - The Lancet, 2018spa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.creativecommonsAtribución-NoComercial 4.0 Internacional (CC BY-NC 4.0)spa
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/spa
dc.sourcehttps://www.sciencedirect.com/science/article/pii/S014067361830802X?via%3Dihubeng
dc.subject.proposalStrokeeng
dc.subject.proposalInterstrokeeng
dc.titlePractice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): An international observational studyeng
dc.typeArtículo de revistaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_6501spa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/articlespa
dc.type.redcolhttp://purl.org/redcol/resource_type/ARTspa
dc.type.versioninfo:eu-repo/semantics/publishedVersionspa
dspace.entity.typePublication
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2spa
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85spa
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