Abstract 183: Acute Ischemic Stroke Treatment in India: Barriers to Access

Introduction Acute ischemic stroke (AIS) is one of the leading causes of disability and mortality in India. Mechanical thrombectomy (MT) is a highly effective new standard of care for large vesselocclusion AIS. However, less than 1.4% of all stroke patients in India are able to receive this treatment inthe appropriate treatment window because of multiple barriers according to the MT GLASS study (Asif etal.,2023) conducted by SVIN_Mission Thrombectomy. In this study, we aim to analyze the barriers toacute stroke treatment, including MT, in India. Methodology From April 2024 to July 2024, we conducted an electronic survey of Indian neurologistsin 9/28 states of India, representing all 5 India Mission Thrombectomy Regional committees, regardingthe most common barriers to local access to acute stroke therapies including MT. Following the survey,we also interviewed 3 of the neurologists with a scripted questionnaire inquiring about access to acutestroke therapies in their regions. We did a statistical analysis of the survey responses using descriptivestatistics. Results We received 14/32 (43.8%) survey responses which included representation from all nine states.The top barriers to stroke treatment per the respondents included a lack of patient awareness of strokesymptoms, financial barriers, and patients’ inability to reach the hospital in time. 9/14 (64.9%) of therespondents had under 20 stroke centers in their state with 8/14 (57.14%) reporting 100‐500 averageannual stroke cases per center. Though MT is available in 85.47% of stakeholders’ regions, 92.86%record that patients do not arrive in time for treatment. Overall, 50% of stakeholders reported that patientsare not able to identify BE FAST. According to neurologists from Madhya Pradesh and Rajasthan, 100%of patients are not able to recognize basic stroke symptoms (BE FAST). Additionally, the cost oftreatment leads many patients to forgo care. According to the survey results, the average cost of stroketreatment is 488,636 rupees ($5823.40), with the average monthly salary being less than 20,000 rupees($238.15) in Rajasthan, West Bengal, and Karnataka ($238.31) (Forbes, 2024). While health insurance inIndia may cover the cost and care of treatment depending on the policy, 92.9% of stakeholders recordedthat patients refuse treatment because of the cost. 100% of respondents reported extremely poorinfrastructure and access to acute stroke care in rural areas as compared to urban areas. Conclusion The prevalence of stroke cases in India underscores the urgency of addressing barriers totreatment. Lack of patient education, treatment cost, and geographical discrepancies act as obstacles totreatment, compromising patients’ health.