The need to scale up stroke care in India’s public health facilities

Stroke is not restricted to the old people, in fact almost one fourth of strokes happen in less than 40 years of age. Prof MV Padma Srivastava discussed different case scenarios that pointed out how time effective management is required to manage  strokes. The time window frame should not exclude patients from thrombolysis within the first three hours. This was recently extended to 4.5 hours so as to cover larger number of patients under the ambit of acute stroke care programme. She referred to the guidelines followed by Indian Academy of Neurosciences (IAN) which states that the only FDA approved treatment for acute ischemic stroke is a thrombolytic agent. She elaborated on the paradigm shift occurring due to  various interventions to improve stroke outcomes such as use of asprin with 48 hours, Hemicraniectomy, IV thrombolysis within 4.5 hours and management of patients.

She further points out that as health is our birth right, it should be available, accessible and affordable. She said that if acute stroke treatment is brought into the CCU, infrastructure and cost will not be very high. It will only require  bringing in training and SOPs in place.

She mentioned that there is a huge treatment gap which requires physicians to step in. To bridge the gap, she further elaborate on the concept of telemedicine which will be available irrespective of social, economic and geographic barriers.

She gave an example of Himachal Pradesh where this programme was conducted. They had collaborated with MoH&FW and brought together the district level CMOs and emergency personnels and trained them. Using the whatsapp-based module, they thrombolysed 176 patients at the district level.

Key recommendations:

• Time effectiveness is required to manage the acute ischemic stroke
• To bridge the huge treatment gap, physicians have to step in along with neurologists.
• The concept of telemedicine should be conducted in other districts as it will help increase the availability, accessibility and affordability