Characteristics, clinical practice patterns and outcomes of strokes in India: INSPIRE - A multicentre prospective study.

BackgroundIndia has a high burden of stroke but there is limited data available on characteristics of patients presenting with stroke in India.AimsWe aimed to document the clinical characteristics, practice patterns and outcomes of patients presenting with acute stroke to Indian hospitals.MethodsA prospective registry study of patients admitted with acute clinical stroke was conducted in 62 centres across different regions in India between 2009 and 2013.ResultsOf the 10,329 patients included in the prescribed registry, 71.4% had ischemic stroke, 25.2% intracerebral haemorrhage (ICH) and 3.4% an undetermined stroke subtype. Mean age was 60 years (SD 14) with 19.9% younger than 50. 65% were male. A severe stroke at admission (modified-Rankin score 4-5) was seen in 62%, with 38.4% of patients having severe disability at discharge or dying during hospitalisation. Cumulative mortality was 25% at 6 months. Neuroimaging was completed in 98%, 76% received physiotherapy, 17% speech and language therapy (SLT), 7.6% occupational therapy (OT), with variability among sites. 3.7% of ischemic stroke patients received thrombolysis. Receipt of physiotherapy (OR 0.41,95% CI 0.33-0.52) and SLT (OR 0.45, 95% CI 0.32-0.65) was associated with lower mortality, while a history of atrial fibrillation (OR 2.22, 95% CI 1.37-3.58) and ICH (OR 2.00, 95% CI 1.66-2.40) were associated with higher mortality.ConclusionsIn the INSPIRE registry, one-in-five patients with acute stroke was under 50 years of age, and one-quarter of stroke was ICH. There was a low provision of thrombolysis, and poor access to multi-disciplinary rehabilitation highlighting how improvements are needed to reduce morbidity and mortality from stroke in India.