Frontiers in stroke · 2026
Acute cerebrovascular disease in the Philippine Neurological Association One Database (PNA1DB)-patient profiles and disparities between public and private hospitals.
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Gan Robert N, Pascual V Jose Leonard R, Collantes Maria Epifania V, Hiyadan John Harold B, Juangco Dan Neftalie A, Macrohon-Valdez Ma Cristina Z, Escabillas Cyrus G, Co Christian Oliver C, Sarapuddin Gemmalynn B, Cañete Maria Teresa A, Alvarez Raquel M, Mesina-Nepomuceno Belinda L, Lokin Johnny K, Lukban Marie Charmaine Sy, Picar Rosalina E
Аннотация
BACKGROUND: Stroke is a leading cause of death in the Philippines, yet data on epidemiology, care, and outcomes remain scarce. We aimed to describe the caseload, patient profile, management, and outcomes of acute cerebrovascular events, and to assess disparities between publicly funded and privately funded tertiary hospitals in the Philippines.
METHODS: The PNA1DB-Stroke project is a prospective, multicenter, registry of consecutive patients aged ≥18 years admitted with transient ischemic attack (TIA), ischemic stroke, hemorrhagic stroke, or cerebral venous thrombosis (CVT) in 11 (five publicly-funded, six privately-funded) accredited neurology training tertiary hospitals across the Philippines. Data on socio-demographics, medical history, event type, clinical assessments, diagnostic procedures, treatments and discharge outcomes were collected from June 1, 2021, to August 31, 2024.
RESULTS: Among the 15,230 cases included, mean age 58.0 ± 14.2 years, 6,726 (44.2%) women, hemorrhagic strokes accounted for 38.6%. A total of 10,974 (72.1%) cases were admitted in public hospitals with a larger proportion of hemorrhagic strokes compared to private hospitals (p < 0.001). Public hospitals cases were younger, socioeconomically disadvantaged, and more often have lifestyle risk factors. Only 620 (9.3%) ischemic stroke cases underwent revascularization. While relatively more cases received thrombolysis in public hospitals, major diagnostic and therapeutic procedures were performed less compared to private hospitals. Overall, in-hospital fatality was 16.4%, higher in public hospitals (20.5%) with worse neurological outcomes at discharge than in private hospitals.
CONCLUSIONS: Our registry demonstrated a high burden of hemorrhagic stroke, delayed hospital arrival, underutilization of reperfusion therapies, and striking disparities between public and private hospitals in the PNA1DB. Study Registration: ClinicalTrials.gov NCT04972058.
METHODS: The PNA1DB-Stroke project is a prospective, multicenter, registry of consecutive patients aged ≥18 years admitted with transient ischemic attack (TIA), ischemic stroke, hemorrhagic stroke, or cerebral venous thrombosis (CVT) in 11 (five publicly-funded, six privately-funded) accredited neurology training tertiary hospitals across the Philippines. Data on socio-demographics, medical history, event type, clinical assessments, diagnostic procedures, treatments and discharge outcomes were collected from June 1, 2021, to August 31, 2024.
RESULTS: Among the 15,230 cases included, mean age 58.0 ± 14.2 years, 6,726 (44.2%) women, hemorrhagic strokes accounted for 38.6%. A total of 10,974 (72.1%) cases were admitted in public hospitals with a larger proportion of hemorrhagic strokes compared to private hospitals (p < 0.001). Public hospitals cases were younger, socioeconomically disadvantaged, and more often have lifestyle risk factors. Only 620 (9.3%) ischemic stroke cases underwent revascularization. While relatively more cases received thrombolysis in public hospitals, major diagnostic and therapeutic procedures were performed less compared to private hospitals. Overall, in-hospital fatality was 16.4%, higher in public hospitals (20.5%) with worse neurological outcomes at discharge than in private hospitals.
CONCLUSIONS: Our registry demonstrated a high burden of hemorrhagic stroke, delayed hospital arrival, underutilization of reperfusion therapies, and striking disparities between public and private hospitals in the PNA1DB. Study Registration: ClinicalTrials.gov NCT04972058.