Universidad Peruana Cayetano Heredia

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

Mostrar el registro sencillo del ítem

dc.contributor.author Langhorne, Peter
dc.contributor.author O'Donnell, Martin J.
dc.contributor.author Chin, Siu Lim
dc.contributor.author Zhang, Hongye
dc.contributor.author Xavier, Denis
dc.contributor.author Avezum, Alvaro
dc.contributor.author Mathur, Nandini
dc.contributor.author Turner, Melanie
dc.contributor.author MacLeod, Mary Joan
dc.contributor.author Lopez-Jaramillo, Patricio
dc.contributor.author Damasceno, Albertino
dc.contributor.author Hankey, Graeme J.
dc.contributor.author Dans, Antonio L.
dc.contributor.author Elsayed, Ahmed
dc.contributor.author Mondo, Charles
dc.contributor.author Wasay, Mohammad
dc.contributor.author Czlonkowska, Anna
dc.contributor.author Weimar, Christian
dc.contributor.author Yusufali, Afzal Hussein
dc.contributor.author Hussain, Fawaz Al
dc.contributor.author Lisheng, Liu
dc.contributor.author Diener, Hans-Christoph
dc.contributor.author Ryglewicz, Danuta
dc.contributor.author Pogosova, Nana
dc.contributor.author Iqbal, Romana
dc.contributor.author Diaz, Rafael
dc.contributor.author Yusoff, Khalid
dc.contributor.author Oguz, Aytekin
dc.contributor.author Wang, Xingyu
dc.contributor.author Penaherrera, Ernesto
dc.contributor.author Lanas, Fernando
dc.contributor.author Ogah, Okechukwu S.
dc.contributor.author Ogunniyi, Adesola
dc.contributor.author Iversen, Helle K.
dc.contributor.author Málaga Rodríguez, Germán Javier
dc.contributor.author Rumboldt, Zvonko
dc.contributor.author Magazi, Daliwonga
dc.contributor.author Nilanont, Yongchai
dc.contributor.author Rosengren, Annika
dc.contributor.author Oveisgharan, Shahram
dc.contributor.author Yusuf, Salim
dc.contributor.author INTERSTROKE collaborators
dc.date.accessioned 2018-11-30T22:50:35Z
dc.date.available 2018-11-30T22:50:35Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/4155
dc.description.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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Aged en_US
dc.subject Middle Aged en_US
dc.subject Case-Control Studies en_US
dc.subject Developed Countries en_US
dc.subject Developing Countries en_US
dc.subject Evidence-Based Medicine en_US
dc.subject Health Services Accessibility en_US
dc.subject Patient Outcome Assessment en_US
dc.subject Poverty en_US
dc.subject Practice Patterns, Physicians' en_US
dc.subject Stroke en_US
dc.subject Surveys and Questionnaires en_US
dc.subject Survival Analysis en_US
dc.subject Treatment Outcome en_US
dc.title Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(18)30802-X
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1474-547X


Ficheros en el ítem

Ficheros Tamaño Formato Ver

No hay ficheros asociados a este ítem.

Este ítem aparece en la(s) siguiente(s) colección(ones)

Mostrar el registro sencillo del ítem

info:eu-repo/semantics/restrictedAccess Excepto si se señala otra cosa, la licencia del ítem se describe como info:eu-repo/semantics/restrictedAccess

Buscar en el Repositorio


Listar

Panel de Control

Estadísticas