E-035 Stroke management and outcomes in low- and lower-middle-income countries: a meta-analysis of 8,535 patients

Abstract

<h3>Background</h3> Strokes affect almost 13 million new people each year and while the outcomes of stroke have improved over the past several decades in high income countries, the same cannot be seen in low- and lower-middle-income countries. <h3>Objective</h3> This is the first study to identify the availability of diagnostic tools along with the rates of stroke mortality and other post-stroke complications in the low-and lower-middle-income countries. <h3>Methods</h3> A search of the literature was completed with a search of the MEDLINE, Embase, and Scopus databases with adherence to the PRISMA guidelines. Studies were included if they reported any outcomes of stroke in low- and lower-middle-income countries as designated by The World Bank classification. A meta-analysis calculating pooled prevalence rates of diagnostic characteristics, and stroke outcomes was completed on all endpoint variables. <h3>Results</h3> A total of 19 studies were included, of which six came from Ethiopia, three from Zambia, two from Tanzania and Iran. A single study from Zimbabwe, Botswana, Senegal, Cameroon, Uganda, and Sierra Leone were included. 5265 (61.7%) had an ischemic stroke, 2124 (24.9%) had hemorrhagic stroke, with remaining 1146 (13.4%) having an unknown type. Among six studies a pooled percentage of patients presenting to hospital within one day was 48.37% (CI, 38.59-58.27; I2=97.0%, P&lt;.01). Pooled in-hospital mortality rate was 19.81% (CI, 15.26-25.31; I2=91%, P&lt;.01), but was higher in a hemorrhagic sub-group 27.07% (CI, 22.52-32.15; I2=54%, P=.05) when compared to ischemic group 13.16% (CI, 8.60-19.62; I2=87%, P&lt;.01). 30-day pooled mortality rate was 23.24% (CI, 14.17-35.70; I2=93%, P&lt;.01). At 30 days, the functional independence (mRS 0-2) pooled rate was 13.10% (CI, 7:50-21.89%; I2=82%, P&lt;.01). <h3>Conclusions</h3> A severe healthcare disparity is present in low- and lower-middle-income countries where there is delayed diagnosis of strokes and increased rates of poor clinical outcomes for these patients. <h3>Disclosures</h3> <b>A. Aguirre:</b> None. <b>J. Rodgers:</b> None. <b>T. Reardon:</b> None. <b>N. Brown:</b> None. <b>N. Shlobin:</b> None. <b>A. Ballatori:</b> None. <b>J. Gendreau:</b> None. <b>S. Shahrestani:</b> None.

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