Telestroke Outcomes and Challenges in a Lower-Middle-Income Country: Experience from the Swasthya Ingit Telestroke
Arpan Dutta1, Arnab Sarkar2, Subhadeep Gupta1
1Department of Neurology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
Introduction:
A global gap exists in access to standard care for ischemic stroke, including thrombolysis. Most thrombolysis-capable centers in India are located in major cities, making it difficult for many patients to reach them within the golden hour. Telemedicine can help facilitate thrombolysis in remote areas. This study aimed to evaluate the outcomes of patients who received thrombolysis under the Swasthya Ingit Telestroke Program in West Bengal, India, and to describe the challenges faced during the program.
Methods:
This multicentric observational study analyzes secondary data collected from the Swasthya Ingit Telestroke Program. It compares the outcomes of patients who received thrombolysis in 32 hospitals that used teleconsultation (telemedicine group) with those treated in 9 hospitals where patients were thrombolyzed under the direct supervision of a neurologist (direct supervision group). Outcome comparisons included functional independence (modified Rankin scale [mRS] score of 0-2 at 90 days), all-cause mortality within 90 days, and symptomatic intracerebral hemorrhage (sICH).
Results:
Since the start of the telestroke program in December 2021, 1,329 patients have received thrombolysis (1,034 in the "telemedicine group" and 295 in the "direct supervision group") through June 2024. After excluding patients without 90-day follow-up data, 1,145 patients were included in the analysis. The two groups showed no significant difference in good functional outcomes (mRS 0-2 at 90 days), mortality, and sICH (p values of 0.833, 0.73, and 0.61, respectively).
Conclusion:
Telemedicine in stroke care has enabled thrombolysis in remote and resource-limited areas. Our study further emphasizes the effectiveness of telemedicine in increasing access to stroke reperfusion therapy in a lower-middle-income country. However, limited awareness prevents many ischemic stroke patients from receiving timely treatments like thrombolysis due to delayed arrival at equipped centers. Stroke awareness campaigns are crucial for the optimal utilization of a telestroke network.
