Ischemic Stroke Management in India: Insights from the Indian Registry of Stroke Care Quality

The quality of stroke care in India is unknown. This multicentric study from the Indian Registry of Stroke Care Quality (RES-Q) provides prospectively entered stroke data from 46 stroke centers across the country. We analyzed demographics, therapeutic interventions, quality metrics, and functional outcomes of ischemic stroke from India.

It was an analysis of prospectively entered data into the RES-Q from 2022 to 2024. The inclusion criteria were patients ≥18 years of age with an acute ischemic stroke or transient ischemic attack based on the AHA/ASA 2019 criteria within 2 weeks of stroke onset. All demographic, clinical, and radiological details were entered into a predesigned proforma. All quality and performance measures in the hospital were collected.

Approximately 80% of all strokes (n = 7,337) during the study period were ischemic. The median age was 61 years (interquartile range [IQR] 52-71), with 67% being male. The median National Institute of Health Stroke Scale at admission was 7 (IQR 4-12). Brain parenchymal imaging was done for all patients, but vascular imaging was performed for 60% of patients only. The thrombolysis rate was 32% with a median door-to-needle time of 37 min. Endovascular thrombectomy was performed in 6.5% of cases. Swallowing assessment was done in 72% of patients within 24 h of admission and 90% received physiotherapy in the stroke unit.

This landmark dataset marks the first comprehensive nationwide effort to assess stroke care quality in India. Routine quality monitoring through platforms like RES-Q can help standardize care, reduce disparities, and enable hospitals to benchmark performance and implement targeted improvements.