Published 30 May 2024

Advancing Stroke Care in India: Evolution, Challenges, and Global Insights

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In a discussion moderated by Anumeha Srivastava, Chief Customer Officer for Qure and lead of the Neurocritical Care Vertical, Dr. Jeyaraj Pandian, President-Elect of the World Stroke Organization and Principal at Christian Medical College, Ludhiana, and Prof. Dheeraj Khurana, Professor and Incharge of the Stroke Program at PGIMER, Chandigarh, explore the current state, challenges, and prospects of stroke care in India. 
National Policies and Advocacy Efforts
Dr. Pandian highlights the significant policy changes in India, including the integration of stroke care into the National Program of Non-Communicable Diseases (NCDs), the revised guidelines by the Ministry of Health and Family Welfare, and the introduction of stroke packages in the Ayushman Bharat universal health coverage scheme.  
The reimbursement package for stroke care has been revised to a reasonable amount, encouraging private players to participate in the program. Additionally, the Stroke Center certification through the World Stroke Organization (WSO) and the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has been initiated, with plans to certify at least ten centers by August. 
Dr. Khurana discusses the increasing incidence of stroke in India, with a focus on the states of Punjab and Haryana. He highlights the challenges faced, including a lack of awareness among healthcare workers and the public, a workforce shortage, and inadequate infrastructure.  
The significant risk factors contributing to the high stroke incidence in these states include high systolic blood pressure, sugars, BMI, smoking, alcohol, and lack of a healthy lifestyle. Dr. Khurana emphasizes the need for a two-pronged approach to address these challenges: increasing awareness and improving treatment accessibility. 
Physician-Led Stroke Model and Technology Integration
Dr. Pandian and Dr. Khurana discuss the physician-led stroke model and the importance of technology integration in improving access to thrombolysis.  
The speakers highlight the challenges in implementing this model, such as physicians' fear of complications and the need for imaging interpretation support.  
The role of technology, particularly telemedicine, in assisting physicians and facilitating decision-making is emphasized.  
Dr. Khurana shares his experience in Punjab and Haryana, where images and data are shared through WhatsApp or cloud-based platforms, enabling quick decision-making and patient referral from district hospitals to tertiary care centers. 
Global Perspectives on Technology-Driven Stroke Care
Dr. Pandian shares a global perspective on technology-driven stroke care, citing examples from China, where a cluster randomized trial demonstrated improved stroke outcomes and thrombolysis rates using AI-driven diagnosis and algorithm-based treatment.  
He also mentions the successful implementation of a telestroke model in Tanzania, Africa, which led to the training of physicians and establishing a stroke unit. 
The speakers emphasize the significance of a digitalized workflow and operational platform over minor accuracy differences. They discuss the potential of AI-enabled platforms and applications in diagnostics, rehabilitation, and community-based care.  
Dr. Pandian shares his experience developing a tele-stroke rehabilitation platform called "ATTEND-2," which aims to empower caregivers at home to manage post-stroke complications and improve outcomes. 
Unique Aspects of Stroke Care in India
Dr. Pandian highlights the public-private partnership model implemented in Punjab for CT scans in district hospitals, which can be replicated in other states and LMICs. Dr. Khurana emphasizes the significance of the growing network of stroke trials funded by the Indian Council of Medical Research (ICMR) and the Ministry of Health. This will lead to multi-center clinical trials focused on local scenarios and clinical problems. 
Dr. Pandian and Dr. Khurana highlight the need for more mobile X-ray units and expanded AI algorithms to cover a broader range of conditions, including Non-Communicable Diseases (NCDs), Chronic Respiratory Diseases (CRDs), and Cerebrovascular Diseases (CBDs). They discuss the potential for scalability in India and the importance of continued collaboration, support, and innovation in transforming healthcare delivery and outcomes. 
The discussion concludes by addressing socioeconomic disparities, engaging community leaders and stroke survivors, and fostering patient support organizations to improve stroke care outcomes in India. The speakers also highlight the unique aspects of stroke care in India, such as the public-private partnership model and the growing network of stroke trials, which can serve as examples for other LMICs. 

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