Abstract Number ‐ 276: Stroke Management and Outcomes in Low‐ and Lower‐Middle‐Income Countries: A Systematic Review of 29,626 Patients

Abstract

Introduction Strokes affects 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. 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. Methods A systematic review 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. Results A total of 24 studies were included, of which seven originated from Ethiopia, three from Zambia, two from Tanzania, Zimbabwe, and Iran. A single study from each of Botswana, Nigeria, Senegal, Ghana, Kenya, Cameroon, Uganda, and Sierra Leone were included. Of these studies the time from symptom onset to diagnosis varied greatly (< 24 hours to 28 days). Out of 20 studies reporting, 95% stated they had access to CT/MRI. Stroke mortality rates differed greatly across included studies with in‐hospital mortality occurring between 5.0%‐35.4% and 30‐day mortality between 11.7%‐60.1%. Good clinical outcomes (mRS score 0–2) was reported by several studies and was found to have a range between 4.9%‐19.6% at 30 days. Conclusions A severe healthcare disparity in access to care is present in low‐ and lower‐middle‐income countries where there is delayed diagnosis of strokes leading to increased rates of poor clinical outcomes for these patients.