Stroke patterns, risk factors, management, and outcomes from hospital-based stroke registries in India

BACKGROUND: India is facing a growing burden of stroke due to population aging, lifestyle changes, and increased exposure to risk factors. However, longitudinal data on stroke patterns and outcomes in India are limited. OBJECTIVES: This study assessed stroke patterns, risk factors, management practices, and outcomes using data from the Hospital-Based Stroke Registries (HBSRs) in India. METHODS: This prospective hospital-based registry included 34,792 stroke cases from 30 centers across India, recorded between 2020 and 2022. Data on demographics, clinical features, risk factors, diagnostics, treatments, and outcomes were collected, with follow-up at 28 days and 3 months. Functional outcome was assessed using the modified Rankin Scale (mRS), along with data on recurrence. RESULTS: The mean age was 59.4 years; 13.8% were aged under 45, 63.4% were male, and 72.1% were from rural areas. Hypertension (74.5%) was the most common risk factor, followed by smokeless tobacco use (28.5%) and diabetes mellitus (27.3%). Ischemic stroke accounted for 60% of cases. Only 20.1% were presented within 4.5 h of symptom onset, while 37.8% of cases presented after 24 h. Motor impairment (74.8%) followed by speech disturbance (51.2%) were the commonest symptoms at onset. Thrombolysis was given in 4.6%, and thrombectomy in 0.7%, of ischemic strokes. At 3 months, 27.8% had died, 29.7% had significant disability (mRS 3-5), and 1.1% had a recurrent stroke. CONCLUSION: In this study, one in 7 stroke were in the young, 2 in 5 patients arrived after 24 h of symptom onset, and thrombolysis and mechanical thrombectomy were underutilized. Over half had poor 3-month outcomes, highlighting the need for improving comprehensive stroke care across India.