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

Langhorne, Peter; O’Donnell, Martin; Chin, Siu Lim; Zhang, Hongye; Xavier, Denis; Avezum, Álvaro; Mathur, Nandini; Turner, Melanie; MacLeod, Mary Joan; López‐Jaramillo, Patricio; Damasceno, Albertino; Hankey, Graeme J.; Dans, Antonio L.; ElSayed, Ahmed; Mondo, Charles; Wasay, Mohammad; Członkowska, Anna; Weimar, Christian; Yusufali, Afzalhussein; Hussain, Fawaz Al; Liu, Lisheng; Diener, Hans‐Christoph; Ryglewicz, Danuta; Pogosova, Nana; Iqbal, Romana; Dı́az, Rafael; Yusoff, Khalid; Oğuz, Aytekin; Wang, Xingyu; Peñaherrera, Ernesto; Lanas, Fernando; Ogah, Okechukwu S; Ogunniyi, Adesola; Iversen, Helle K.; Málaga, Germán; Rumboldt, Zvonko; Magazi, Daliwonga Sithembele; Nilanont, Yongchai; Rosengren, Annika; Oveisgharan, Shahram; Yusuf, Salim

doi:10.1016/s0140-6736(18)30802-x

Cited by 108 publications

(89 citation statements)

References 23 publications

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“…Patients from higher‐income countries had lower rates of protocol completion, higher rates of adverse events, and similar mortality rates compared to lower‐ and middle‐income countries . The importance of socioeconomic status on access to medication, lifestyle, treatment quality and clinical outcomes is also apparent beyond HF, and was shown to be relevant in the treatment of stroke and secondary prevention of cardiovascular events in populations at risk . For example, patients from low‐income countries are more likely to be smokers, which might be an important opportunity for intervention .…”

Section: Socioeconomic Determinants As Drivers Of Enrolment and Outcomesmentioning

confidence: 99%

“…18 The importance of socioeconomic status on access to medication, lifestyle, treatment quality and clinical outcomes is also apparent beyond HF, and was shown to be relevant in the treatment of stroke and secondary prevention of cardiovascular events in populations at risk. [64][65][66] For example, patients from low-income countries are more likely to be smokers, which might be an important opportunity for intervention. 11 Device usage also seems to be driven by socioeconomic determinants, with data from ASIAN-HF showing a strong association between underusage of devices in eligible patients with HFrEF and country income level as well as out-of-pocket costs.…”

Section: Influence Of Socioeconomic Determinants On Patient Charactermentioning

confidence: 99%

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Heart failure around the world

Tromp

Ferreira

Janwanishstaporn

et al. 2019

European J of Heart Fail

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With increasingly large sample sizes required to demonstrate event reduction, heart failure outcome trials are no longer being performed in a small group of selected patients and countries, but at a global scale with worldwide contribution of patients from countries with considerable differences in background therapy, socioeconomic status and healthcare practices. Recent studies have highlighted how socioeconomic determinants rather than geographical factors may underlie the heterogeneity of patient populations across the globe. Therefore, in this review, we evaluated (i) regional differences in patient characteristics and outcomes in recent epidemiologic studies; (ii) regional differences in worldwide representativeness of clinical trial populations; and (iii) the role of socioeconomic determinants in driving country differences in heart failure trial enrolment and clinical outcomes.

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Section: Socioeconomic Determinants As Drivers Of Enrolment and Outcomesmentioning

confidence: 99%

Section: Influence Of Socioeconomic Determinants On Patient Charactermentioning

confidence: 99%

Heart failure around the world

Tromp

Ferreira

Janwanishstaporn

et al. 2019

European J of Heart Fail

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“…Similar to other resource‐poor regions, recent research indicates access and delivery of quality and evidence‐based stroke care in Africa is limited and often poor . Studies in Ghana, Senegal and Congo further exemplify the limited nature of access to quality and evidence‐based stroke care in LMICs.…”

Section: Introductionmentioning

confidence: 95%

“…This burden has been largely attributed to the poor quality of care delivered in those settings and the low uptake of evidence‐based practice . Findings from the recent INTERSTROKE study further underscore the poor and limited access to optimal stroke care, leading to poor patient outcomes in LMICs …”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7] Findings from the recent INTERSTROKE study further underscore the poor and limited access to optimal stroke care, leading to poor patient outcomes in LMICs. 8 Similar to other resource-poor regions, recent research indicates access and delivery of quality and evidence-based stroke care in Africa is limited and often poor. 3,4,[8][9][10] Studies in Ghana, 5 Senegal 6 and Congo 7 further exemplify the limited nature of access to quality and evidence-based stroke care in LMICs.…”

Section: Introductionmentioning

confidence: 99%

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Improving the quality of care for people who had a stroke in a low‐/middle‐income country: A qualitative analysis of health‐care professionals’ perspectives

Baatiema

Aikins

Abimbola

et al. 2020

Health Expectations

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Background and Objective Efforts to improve the adoption of evidence‐based interventions for optimal patient outcomes in low‐/middle‐income countries (LMICs) are persistently hampered by a plethora of barriers. Yet, little is known about strategies to address such barriers to improve quality stroke care. This study seeks to explore health professionals’ views on strategies to improve quality stroke care for people who had a stroke in a LMIC. Methods A qualitative interview study design was adopted. A semi‐structured interview guide was used to conduct in‐depth interviews among forty stroke care providers in major referral centres in Ghana. Participants were from nursing, medical, specialist and allied health professional groups. A purposive sample was recruited to share their views on practical strategies to improve quality stroke care in clinical settings. A thematic analysis approach was utilized to inductively analyse the data. Results A number of overarching themes of strategies to improve quality stroke care were identified: computerization and digitization of medical practice, allocation of adequate resources, increase the human resource capacity to deliver stroke care, development of clinical guideline/treatment protocols, institutionalization of multidisciplinary care and professional development opportunities. These strategies were however differentially prioritized among different categories of stroke care providers. Conclusion Closing the gap between existing knowledge on how to improve quality of stroke care in LMICs has the potential to be successful if unique and context‐specific measures from the views of stroke care providers are considered in developing quality improvement strategies and health systems and policy reforms. However, for optimal outcomes, further research into the effectiveness and feasibility of the proposed strategies by stroke care providers is needed.

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