Disparities in the Management of Acute Stroke in Latin America: A Systematic Review.

Jorge Vargas-Rojas, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
Paul Lewis, Columbia University Vagelos College of Physicians and Surgeons., New York, United States


Acute ischemic stroke represents a major health burden worldwide as it leads to an increasing morbidity and mortality and is the second leading cause of disability. In recent years, developing regions like Latin America and the Caribbean have surpassed primarily industrialized nations as the main sources of the global burden of stroke. This article aims to explore the disparities in the management strategies for stroke in Latin America. 

Participants and Methods:

A systematic review was conducted following PRISMA guidelines using various iterations of keywords such as "stroke", "Latin America", and "precision medicine" in three databases: PubMed, Google Scholar, and Scielo. Articles in English and Spanish published between January 2018 and August 2023 were included yielding 389 articles after duplicate removal for screening. 260 articles were excluded after reading abstracts due to not focusing on management of acute stroke in adults. 129 records went through a full-text analysis and 104 articles were excluded based on location (not in Latin America or the Caribbean) and relevance. 25 articles were included in the final qualitative synthesis.


Findings were divided into three categories: personalized diagnostics, tailored therapeutics, and perception of care. In Latin American countries, risk factors such as history of hypertension (OR 2.98), alcohol intake (OR 2.09), smoking (OR 1.67) and diabetes mellitus (OR 1.16) were found to be associated with 90% of stroke risk. By targeting high systolic blood pressure and body mass index, the burden of stroke could be reduced by 53% and 37% respectively. Whole genome sequencing for stroke types and subtypes in ancestrally diverse populations including Hispanic/Latino populations identified 13q33 for large arteries to be associated with  hemorrhagic stroke (OR 1.52×108, P<5.00×10-9). Both Latin American patients and patients from developed countries did not differ in outcomes after thrombolysis with r-tPA (p=0.8). Mortality in studies of patients from developing nations like the Costa Rican Stroke Registry Program was higher (7.3%) compared to those in developed nations like the CLOTBUST-ER trial (0.7%), and region was  associated with higher NIH Stroke Scale scores, older age, and longer time to treatment in the Latino population (p=0.006). Similarly, in the RESILIENT trial, Brazilian patients who underwent mechanical thrombectomy, experienced higher mortality (29%) compared to trials from developed countries such as EXTEND IA (9%) and ESCAPE (10.4%). The most relevant approach to improve the outcomes of stroke was the use of acute stroke units; however, limited access was a challenge in Latin America. While there are 156 stroke specialized centers in Brazil, there is only one acute stroke unit in Ecuador. Hispanic-American patients worried about structural constraints, racism and inequities in healthcare.


An essential aspect of stroke management is ensuring equitable access to diagnostic tools, treatments, and specialized care. Latin America faces significant challenges in terms of healthcare infrastructure, funding, and geographical disparities, making it crucial to address these issues to ensure that timely interventions benefit all stroke patients.

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: stroke
Keyword 2: cardiovascular disease
Keyword 3: ethnicity