Arpan Dutta, Arnab Sarkar, Subhadeep Gupta, Uddalak Chakraborty, Chayan Mondal, Soumozit Banerjee, Deep Das, Debabrata Pulai, Alapan Paul, Snehansu Shekhar Samanta, Sujoy Sarkar, Susanta Chakrabarty, Chinmoy Barik, Diptak Bhowmick, Sanat Kumar Jatua, Snehasis Das, Samiran Misra, Biswajit Ray, Phalguni Das, Binod Das, Barun Das, Avijit Naskar, Dhiraj Roy, Bichitra Biswas, Amit Kumar Das, Dipanjan Das, Aniruddha Sarkar, Rabiul Alam, Kaushik Pal, Kalyan Kumar Das, Samir Kanta Datta, Jishnu Bhattacharya, Somnath Ghosh, Sishir Kumar Naskar, Prasenjit Majumdar, Gautam Ghosh, Amit Dutta, Amit Kumar Ghosh, Souvik Sen, Soumya Ghosh, Nitai Chandra Mandal, Subhransu Sekhar Datta, Asit Kumar Biswas, Swapan Saren, Rahul Kumar, Shashvat M Desai, Ashutosh P Jadhav, Jeyaraj Durai Pandian, Manimoy Bandopadhyay, Biman Kanti Ray
{"title":"Telestroke outcomes and challenges in a lower-middle-income country: experience from the Swasthya Ingit Telestroke Program of West Bengal, India.","authors":"Arpan Dutta, Arnab Sarkar, Subhadeep Gupta, Uddalak Chakraborty, Chayan Mondal, Soumozit Banerjee, Deep Das, Debabrata Pulai, Alapan Paul, Snehansu Shekhar Samanta, Sujoy Sarkar, Susanta Chakrabarty, Chinmoy Barik, Diptak Bhowmick, Sanat Kumar Jatua, Snehasis Das, Samiran Misra, Biswajit Ray, Phalguni Das, Binod Das, Barun Das, Avijit Naskar, Dhiraj Roy, Bichitra Biswas, Amit Kumar Das, Dipanjan Das, Aniruddha Sarkar, Rabiul Alam, Kaushik Pal, Kalyan Kumar Das, Samir Kanta Datta, Jishnu Bhattacharya, Somnath Ghosh, Sishir Kumar Naskar, Prasenjit Majumdar, Gautam Ghosh, Amit Dutta, Amit Kumar Ghosh, Souvik Sen, Soumya Ghosh, Nitai Chandra Mandal, Subhransu Sekhar Datta, Asit Kumar Biswas, Swapan Saren, Rahul Kumar, Shashvat M Desai, Ashutosh P Jadhav, Jeyaraj Durai Pandian, Manimoy Bandopadhyay, Biman Kanti Ray","doi":"10.1159/000548264","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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 aims 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.</p><p><strong>Methods: </strong>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 nine hospitals where patients were thrombolysed 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 haemorrhage (sICH).</p><p><strong>Results: </strong>Since the start of the telestroke program in December 2021, 1329 patients have received thrombolysis (1034 in the 'Telemedicine group' and 295 in the 'Direct supervision group') through June 2024. After excluding patients without 90-day follow-up data, 1145 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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-13"},"PeriodicalIF":1.5000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000548264","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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 aims 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 nine hospitals where patients were thrombolysed 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 haemorrhage (sICH).
Results: Since the start of the telestroke program in December 2021, 1329 patients have received thrombolysis (1034 in the 'Telemedicine group' and 295 in the 'Direct supervision group') through June 2024. After excluding patients without 90-day follow-up data, 1145 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.
期刊介绍：
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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