Stroke Scenario in India

DR SUDHIR KUMAR MD DM

CONSULTANT NEUROLOGIST

Apollo Hospitals, Hyderabad

Stroke is the 2nd most common killer amongst all Non-communicable diseases1

~15.4

Lakh

People2

Stroke can affect anyone at anytime

~6.3

Lakh3

Deaths every year because of stroke

~41%Patients do not survive stroke

In addition, ~64 Lakh life years are lost due to disability caused by stroke4

1. Strong, K., C. Mathers and R. Bonita (2007). "Preventing stroke: saving lives around the world." Lancet Neurol 6(2): 182-187.2. F Taylor and K Suresh Kumar. South Asia Network for Chronic disease, IIPH, Hyderabad, PHFI. 20123. World Health Organisation. Preventing Chronic Diseases: A vital investment. Geneva, Switzerland. 2005.4. World Health Organisation. Measurement in health. Statistics Tables 2009

STROKE EPIDEMIOLOGY

• Prevalence: 84-262/100,000 in rural areas, and 334-424/100,000 in urban areas (Pandianet al, J stroke, 2013)

• Incidence: 119-145/100,000 population

Journal of Stroke 2013;15(3):128-134

India Seems to have higher proportion of Hemorrhagic stroke cases than the west: 15-32 % as per various Indian Registries

28 day Case Fatality Rates due to stroke in India

Journal of Stroke 2013;15(3):128-134

Stroke Scenario – India

India

Population of India:1295 Mn2

Sources: 1. Journal of Stroke 2013;15(3):128-1342. Boehringer Ingelheim India – data on file

1648 2300 2975

5900

9200

12286

0

2000

4000

6000

8000

10000

12000

14000

2009 2010 2011 2014 2015 2016

AIS Patients Treated across India1,2

7TAMILNADU

2015 2016

1.000.65

KARNATAKA

2015 2016

1.150.91

MAHARASHTRA

& Goa

2015 2016

1.631.27

GUJARAT

2015 2016

0.850.70

AP & MP

2015 2016

0.580.44

East

2015 2016

0.120.06

U.P.

2015 2016

0.070.06

Comparison of Region

Wise Lysis Rates* in 2015

and 2016 (in %)

Source: Boehringer Ingelheim India – data on file

Extrapolated from Vial usage data in India

* - Denominator is all stroke patients

Delhi &

Haryana

2015 2016

3.46 4.68

KERALA

2015 2016

1.931.93 2.45

PUNJAB & HP

2015 2016

1.151.15 1.60

Quality parameters for stroke treatment in India: DTN* and lysis rates

• Lack of published data available

• The lysis rates have improved in the region from 0.69 % in 2014 to 1.06 % in 2015 and now in 2016, lysis rates are 1.23 %

• A tertiary center from India reported only 15 % of thrombolysed patients to have a DTN <60 minutes.

*- Door to Needle

Source: Boehringer Ingelheim India – data on fileIndian J Crit Care Med. 2015 May; 19(5): 265–269

Journey from 12200 40000.What are the possible gaps that could be addressed?

Targeted Awareness

Emergency / Casualty team coordination

Confident Stroke Physician

24X7 Diagnostic services

Inter departmental Flexibility

Stroke Team along with Stroke Unit

Public awareness

Comments/queries?

drsudhirkumar@yahoo.com

THANKS