Short- and Long-Term Management and Prognosis of Stroke in China: Findings from a Large Nationwide Stroke Registry

Background There is limited nationwide evidence about the standard short- and long-term management of stroke types and prognosis in China. Methods A nationwide registry recruited 14,244 imaging-confirmed incident strokes from 132 hospitals across 31 provinces of China during 2007-8, recording presenting characteristics, diagnostic procedures, and in-hospital treatment. After hospital discharge, patients were followed up for 12 months. Conventional statistical methods were used to examine the patterns of management and prognosis. Findings Overall, 68.7%, 26.9%, and 4.4% were ischaemic stroke (IS), intracerebral haemorrhage (ICH) , and subarachnoid haemorrhage (SAH) respectively. Only 20% were managed in a dedicated stroke unit. Among IS admitted <3 hours of symptom onset, 1.3% received thrombolysis, whereas the proportions of receiving in-hospital antithrombotic therapy, neuroprotective agents, and Traditional Chinese Medicines (TCM) were 88.4%, 69.7%, and 70.6% respectively. For ICH, 63.3% and 36.3% received neuroprotective agents and TCM in hospital, respectively. At discharge, 70.7%, 39.1%, and 38.0% of the IS patients were given antiplatelet, antihypertensive, and statin therapies, respectively, decreasing to 45.5%, 27.5%, and 9.7%, respectively, at 12 months. In-hospital mortality were 3.2%, 9.3% and 10.1% for IS, ICH and SAH respectively, with a further 12.1%, 25.4% and 28.0%, respectively, died by 12 month. Interpretation In China, most strokes were not managed in specialised stroke unit. There was widespread use of some unproven therapies but limited proven treatments, especially after discharge, leading to unnecessary recurrent and mortality risks. Funding: Ministry of Science and Technology and the Ministry of Health of the People’s Republic of China. Declaration of Interest: We declare that we have no conflicts of interest. Ethical Approval: The study was approved by the Central Ethics Committee at Beijing Tiantan Hospital affiliated to Capital Medical University. Written informed consent was obtained from all patients or their legal representatives.