Comparison of primary and secondary stroke outcomes between government and private healthcare institutions: insights from the SPRINT India trial

Introduction: analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals. Methods: SPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models. Results: = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index. Conclusions: Stroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context. Clinical trial registration: http://ctri.nic.in, identifier: CTRI/2017/09/009600.

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Journal
Frontiers in Stroke
Published
2026-04-13
DOI
https://doi.org/10.3389/fstro.2026.1805422
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
0.00
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article

Comparison of primary and secondary stroke outcomes between government and private healthcare institutions: insights from the SPRINT India trial

Rupjyoti Das, Madhusudhan Byadarahalli Kempegowda, Nomal Chandra Borah, Jayanta Roy et al.
Frontiers in Stroke
Acute Ischemic Stroke Management
article

Comparison of primary and secondary stroke outcomes between government and private healthcare institutions: insights from the SPRINT India trial

Rupjyoti Das, Madhusudhan Byadarahalli Kempegowda, Nomal Chandra Borah, Jayanta Roy, Y Muralidhar Reddy, Sankar Prasad Gorthi, Vijaya Pamidimukkala, Aneesh Dhasan, Aralikatte Onkarappa Saroja, Neetu Ramrakhiani, Rupinder Singh Dhaliwal, Deepti Arora, Biman Kanti Ray, Sudhir Sharma, Sunil K. Narayan, Ivy Sebastian, Paramdeep Kaur, Vivek Nambiar, Ravi Bhatia, Dheeraj Khurana, Anand Vaishnav, Somasundaram Kumaravelu, Abhishek Pathak, Tina George, Pawan Kumar Ojha, GB Kulkarni, Shweta Jain Verma, Arya Devi K S, Sanjeev Kumar Bhoi, P. N. Sylaja, Vikram Huded, Sanjith Aaron, Aparna R. Pai, Jeyaraj D. Pandian, Gaurav Mittal, Thomas Mathew, Sulena Sulena, Arvind Sharma, Bhavya Nanda, Mahesh Kate
article en

Abstract

Introduction: analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals. Methods: SPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models. Results: = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index. Conclusions: Stroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context. Clinical trial registration: http://ctri.nic.in, identifier: CTRI/2017/09/009600.

Frontiers in StrokeVol. 5
Amrita Institute of Medical Sciences and Research Centre (IN), University of British Columbia (CA), St. John's University (US), University of Alberta (CA), St. John's College of Nursing (US), Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals (IN), Christian Medical College, Vellore (IN), Neurosciences Institute (US), Indira Gandhi Medical College (IN), Sree Chitra Thirunal Institute for Medical Sciences and Technology (IN), Guru Gobind Singh Medical College and Hospital (IN), Bangur Institute of Neurosciences (IN), Max Super Speciality Hospital (IN), CARE Hospitals (IN), Narayana Health (IN), Stephens College (US), Indian Council of Medical Research (IN), Indira Gandhi Medical College and Research Institute (IN), Kasturba Medical College Hospital (IN), Institute of Post Graduate Medical Education and Research (IN), Indian Institute of Information Technology Vadodara (IN), Christian Medical College (IN), Fortis Escorts Hospital (IN), Kasturba Hospital (IN), KLE Academy of Higher Education and Research (IN), Fortis Escorts Hospital (IN), Zydus Lifesciences Limited (India) (IN), Post Graduate Medical Institute (PK), BGS Global Hospital (IN), Neurological Surgery (US), Sir Ganga Ram Hospital (PK), Institute of Medical Sciences (IN), Jawaharlal Institute of Post Graduate Medical Education and Research (IN), All India Institute of Medical Sciences (IN), Higher Education Academy (GB), National Institute of Mental Health and Neurosciences (IN), Banaras Hindu University (IN)
Good health and well-being
Openalex Percentile: Top 27%
Acute Ischemic Stroke Management
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