Assessment of Acute Stroke Care, Metrics and Outcomes: Analysis from the Pre-implementation Phase of the IMPETUS Study

BackgroundStroke is a major cause of death and disability in India. Despite national programs and guidelines, stroke care continues to face challenges. Many stroke patients seek care at government medical colleges. To date, there are no studies from India that comprehensively assessed the quality of acute stroke care. This study aims to evaluate acute stroke care in its pre-implementation phase across 22 medical colleges using key indicators for optimal care. MethodsIMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases, initiated in October 2021. During its pre-implementation phase, a baseline assessment of the existing components of stroke care was performed using pre-structured case report form, among prospectively enrolled acute stroke patients at 22 medical colleges. ResultsA total of 2,018 patients were enrolled during the pre-implementation phase. Mean (SD) age was 59 (14) years with male preponderance (64%); 69% had an onset <24 hours, majority had ischemic stroke (60%), followed by ICH (38%). Key risk factors were hypertension (80%), diabetes (30%), smoking (22%), alcohol abuse (24%) and previous stroke (21%). Imaging performed: CT (69%), CTA (18%) and MRA (14%). Intravenous thrombolysis was administered in 39% eligible, predominantly with TPA (72%). In-hospital delay was the most common reason for not receiving thrombolysis (44%). The status of stroke time metrics (in minutes) was: onset-to-door 660 (IQR 285-1682), door-to-CT 95 (IQR 46-274), onset-to-needle 201 (165-250), CT-to-needle 36 (23-50), and door-to-needle time 67 (48-90). Other important stroke care indices were also evaluated. In-hospital mortality was 19% and 33% of patients achieved modified Rankin scale score 0-2 at 90-days. ConclusionThese comprehensive data provide a representative baseline status of acute stroke care in India, which will be useful in comparing advancements of stroke care during the implementation phase of the study and improve policy making.