Dr.P.N Sylaja

Professor of Neurology

Head,Comprehensive Stroke Care Program

Sree Chitra Tirunal Institute of Medical Sciences and Technology

Trivandrum,Kerala , India

MT 2020 India

Stroke Burden in India

Trivandrum Stroke Registry (2009)

Incidence - 135 per 100,000

Ischemic stroke – 74.8 % and 14.3 % hemorrhagic stroke

Case fatality rate at 28 days – 37.1% (Rural) 24.5% (urban)

Ludhiana Stroke Registry (2012)

Incidence – 162.3 per 100,000

Ischemic stroke – 73 % and 25.7 % hemorrhagic stroke

Kolkata Stroke Registry (2007)

Incidence – 145.3 per 100,000

Case fatality rate at 30 days – 41.08%Stroke 2009;40:1212-8,

Stroke 2007;38:906-910

Neurology 2016;86:425-33

45,053, 39 villages

Crude prevalence rate: 388.4/100,000

Age adjusted prevalence: 535/100,000

12% Brain imaging

Stroke mortality in rural India

India –Statistics

1.5 Million Strokes every year

3,000-4,000 strokes every day in India

Public awareness of stroke symptoms

Only 55% of the urban population was aware of one warning symptom

of stroke; 16.2% were aware of two symptoms; and only 6.2% could

identify three symptoms.

The recent survey reveals no meaningful improvement of knowledge

among general public regarding stroke, and hence there is an urgent need

for stepping up awareness drive in our country.

Das K et al. J Clin Neurosci 2007;14:12-16.

Pandian JD et al.Stroke 2005;36:644-8.

Menon B et al.J Stroke and Cerebrovasc dis 2014;23:2091-8

Transportation and hospitalization

Rural-based study documented that the mean arrival time of stroke patients was 34 ± 6 h

Factors for delay in arrival

Distance from hospital

Advice of friends and local doctor

low threat perceptions of symptoms

Education

socioeconomic status

Poor availability of transport in rural areas and congestion in urban areas

are barriers to immediate hospitalization and initiation of treatment

A hospital-based study from northwest India has documented that only 12% of patients

came by ambulance

Banerjee TK et al. Ann Indian Acad Neurol 2016;19:1-8

Prehospital care in India

Dial 108 for an ambulance

Implemented across 29 states

Challenges- private and government sector

coordination

Not stroke specific, mostly for trauma patients

Stroke 2017

1.8 % patients were brought by paramedics

52 % by private transportation

Pandian et al .Top Stroke Rehabil 2012;19:384-94.

Ayurvedic massageHerbal medicine

Marma Therapy

Reiki Therapy

Yoga therapy

Stroke scenario in India

12

Incidence of stroke:1,600,000

Don’t arrive in hospital:131,072

Arrive in hospital:278,528

Cannot receive

treatment:194,969

Can Receive treatment:

83,558

No thrombolytic:

25,067

Thrombolysis

Eligible:

58,491

32% seek medication at home

AIS Patients:409,60080% of all stroke

are AIS

70% of patients are outside

the time window

• 30% of patients deny

treatment due to:

• Consent

• Non availability in govt

institutes

• Lack of coverage in

periphery hospitals

Incidence of stroke in urban:512,000Urban Indian

population(32%)

Taylor F , Kumar S . Updated 2012. Stroke in India Fact Sheet, IIPH, Hyderabad ;

Stroke. 2013;44:870-947

Ann Indian Acad Neurol. 2015; 18: 162–166.

Intravenous thrombolysis over the years in India

Source : BI

Intravenous thrombolysis state wise trends over the years

Source : BI

Centres with stroke thrombolysis

More than 500 centers IVT  

  

Number of UAs/Towns and Out Growths(OGs)

Number of UAs/Towns and Out Growths (OGs):

At the Census 2011 there are 7,935 towns in the country. The number of towns has

increased by 2,774 since last Census. Many of these towns are part of UAs and the rest are

independent towns. The total number of Urban agglomerations/Towns, which constitutes

the urban frame, is 6166 in the country.

Type of Towns/UAs/OGs Number of towns

2011

Number of

towns 2001

Towns 7,935 5,161

Statutory Towns 4,041 3,799

Census Towns 3,894 1,362

Urban Agglo. 475 384

Out Growths 981 962

Population 1,336,286,256 (July

2016 est.)

Density 383 people

per.sq.km (2011 est.)

Stroke units in India- What is happening

now?

Stroke units in district hospitals and medical colleges

Physician based model

Training to physicians

Telestroke

Funds available for starting stroke units in government

medical colleges

Most of these are driven by stroke neurologists

10 Stroke units in Kerala under

Government sector

Thiruvananthapuram General Hospital

Kollam District Hospital

Pathanamthitta General Hospital

Alappuzha General Hospital

Kottayam General Hospital

Ernakulam General Hospital

Thrissur General Hospital

Malappuram District Hospital

Palakkad District Hospital

Kozhikode General Hospital

Baptist Christian Hospital, Tezpur,

Assam

Pre-stroke unit implementation

(Demography, stroke symptoms and

signs, stroke severity, type of stroke,

stroke classification, imaging, risk

factors, medications, length of stay,

complications, 30 days FU): N=125

Post-stroke unit implementation:

n=125

“Telestroke”: An Indian Approach to Telemedicine

Padma MV. “Telestroke”: An Indian approach to telemedicine. J Pract Cardiovasc Sci 2017;3:2-4.

Total states in India No. of States with

EVT centres

No. of States without

EVT centres

29 18 11

18

11

112

12

0

20

40

60

80

100

120

Private Govt

Private hospitals Government Sector Total

112 12 124

Int. Radiologist Int. Neurologist Int. Neuro surgeon

105 60 64

We need about 20,000/year

85 Res-Q Centres : India, Private - 73 ; Govt : 12

Uttar Pradesh

# of Centres - 6

# of Govt. – 3

# of Pvt. - 3

# of Centres - 18# of Govt. - 1# of Pvt. - 17

Maharashtra

# of Centres – 2# of Pvt – 2# of Govt - 0

Assam & entire North East

# of Centres - 1# of Govt. - 0# of Pvt. - 1

West Bengal

Orissa

LEAVE YOUR LEGACY

# of Centres - 1# of Govt. - 0# of Pvt. - 1

Rajasthan

# of Centres - 6# of Govt. - 0# of Pvt. - 6

Gujarat

Madhya Pradesh

# of Centres - 4# of Govt. - 0# of Pvt. - 4

Karnataka

# of Centres - 14# of Govt. - 2# of Pvt. - 12

AP & Telangana

# of Centres - 6# of Govt. - 0# of Pvt. - 6

Tamil Nadu

# of Centres - 6# of Govt. - 1# of Pvt. - 5

Punjab & Chd Himachal Pradesh

# of Centres - 1

# of Govt. - 1

# of Pvt. - 0

Delhi

# of Centres - 10

# of Govt. - 1

# of Pvt. - 9

# of Centres - 7# of Govt. - 3# of Pvt. - 4

Kerala

# of Centres - 3# of Govt. - 0# of Pvt. - 3

Haryana Total Govt Pvt

Assam 2 0 2

Chandigarh 1 1 0

Delhi 10 1 9

Gujarat 6 0 6

Haryana 3 0 3

Himachal Pradesh 1 1 0

Karnataka 4 0 4

Kerala 7 3 4

Maharashtra 18 1 17

Punjab 5 0 5

Rajasthan 1 0 1

Tamilnadu 6 0 6

Telangana 14 2 12

UP 6 3 3

West Bengal 1 0 1

All India 85 12 73

State WiseRes-Q Centres

Res-Q globally

Example of Quarterly data analysis on all parameters

EVT – for the future ---------

Stroke thrombectomy centre certification –NABH

Stroke unit certification

Training of stroke neurologists in stroke intervention

Stroke intervention fellowships

Regional meetings on acute stroke management

Cost of thrombectomy devices needs to come down.

Health insurance to be made compulsory

Thankyou