Background: Stroke is a key contributor to the global burden of disease and the second leading cause of death worldwide. Efforts to measure and improve care are rapidly extending to low and middle income countries. Yet there is lack of comparative assessment of characteristics and adherence to evidence-based performance measures in acute ischemic stroke for most world regions.
Methods: We analyzed data of consecutive acute ischemic stroke patients in the Get With The Guidelines Stroke (n=194,876 from 1548 sites) and the China National Stroke Registry (n=19,604 from 217 sites) between 2012 and 2013. Patient characteristics and adherence to guideline-based performance measure in both countries were compared.
Results: Compared with their US counterparts, Chinese patients were much younger (mean 64.8 vs. 70.5 years), had lower prevalence of comorbidities except for prior stroke/TIA and smoking, had less severe stroke (NIHSS, mean 5.4 vs. 6.8) and more delay from symptom onset to arrival (median 22 vs. 11 hours) (all p<.001). Overall, use of intravenous thrombolytic therapy was 2.4% in China (tPA 1.4% and urokinase 1.0%) and 8.1% in US (tPA). Chinese compared with US patients experienced more treatment delay (door-to-needle time, median 95 vs. 62 minutes, p<.001). Adherence to early and discharge antithrombotics, smoking cessation counseling, and dysphagia screening were fairly high in China (>80%), although numerically lower than in the US. The largest differences between performance measure adherence in Chinese and US care were seen in timeliness of tPA treatment, venous thromboembolism prophylaxis, lipid lowering therapy, anticoagulation for atrial fibrillation, and rehabilitation assessment (Figure).
Conclusion: We found important differences in clinical characteristics and gaps in adherence to certain performance measures between China and the US. National efforts are needed for continued improvements in acute ischemic stroke care in both countries.