A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care &amp; the Houston Experience

Reddy, Sujan; Satani, Nikunj; Beauchamp, Jennifer E S; Selvaraj, Sudhakar; Rajan, Suja S.; Rahbar, Mohammad Hossein; Tahanan, Amirali; Kim, Sori; Holder, Travis Ford; Jiang, Xiaoqian; Chen, Luyao; Kamal, Haris; Indupuru, Hari; Wu, Tzu Ching; Savitz, Sean I

doi:10.1002/acn3.51322

Cited by 18 publications

(14 citation statements)

References 42 publications

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“…One important point in the current pandemic is related to stroke management. A global decline in the use of intravenous thrombolysis and thrombectomy has been reported [14] , [17] . It is controversial whether the proportion of patients receiving reperfusion therapy has increased in the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

Haki

Deniz²

2022

Clinical Neurology and Neurosurgery

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Section: Discussionmentioning

confidence: 99%

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

Haki

Deniz²

2022

Clinical Neurology and Neurosurgery

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“…10 The increase in the number of ICH cases in the first wave compared to the pre-pandemic period was intriguing because worldwide, there was a reduction in ICH cases during the first wave. 1,11 Reduced access to health care due to restrictions created by lockdown and fear of getting infected, hypertensive patients would have poor control of hypertension which may have contributed to the rise in ICH. ICH strokes would have caused more severe strokes (as evidenced by higher NIHSS) due to which patients were forced to attend hospitals which may be another reason for the increase in the number of ICH cases.…”

Section: Discussionmentioning

confidence: 99%

“…There was a reduction in stroke admissions and delay in time metrics in stroke care worldwide. [1][2][3] Fear of contracting the infection from hospitals and strict lockdown measures, including the stay-at-home campaign, contributed to this. Nevertheless, Indian data during the first wave showed no drop in stroke admissions, but there was a delay in stroke metrics.…”

Section: Introductionmentioning

confidence: 99%

Intracerebral hemorrhage during the pandemic- Learning from experience

Iype¹,

Ramachandran

Panicker³

et al. 2022

IJN

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Worldwide stroke care was affected by COVID 19 pandemic and the majority of the literature was on ischemic stroke. Intracerebral hemorrhage (ICH) accounts for about one-fourth of strokes worldwide and has got high mortality and morbidity. We aimed to study the effect of the Pandemic on ICH outcomes and flow metrics during the first wave compared to the pre-pandemic period and how that experience was made used in managing ICH during the second wave. Ours was a single-center observational study, where consecutive patients with non-COVID spontaneous ICH aged more than 18 years who presented within 24 hours of last seen normal were included in the study. We selected the months of June, July, and August in 2021 as the second wave of the pandemic, the same months in 2020 as the first wave of the pandemic, and the same months in 2019 as the pre-pandemic period. We compared the 3-month functional outcomes, in hospital mortality and workflow metrics during the three time periods. We found poor three-month functional outcomes and higher hospital mortality during the first wave of the COVID 19 pandemic, which improved during the second wave. In-hospital time metrics measured by the door to CT time which was delayed during the first wave improved to a level better than the pre-pandemic period during the second wave. ICH volume was more during the first and second waves compared to the pre-pandemic period. Other observations of our study were younger age during the second wave and higher baseline systolic BP at admission during both pandemic waves. Our study showed that functional outcomes and flow metrics in ICH care improved during the second wave of the pandemic through crucial re-organization of hospital stroke workflows. We are sharing this experience because we may have to do further rearrangements in future as the upcoming times are challenging due to new variants emerging.

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“…The SARS-CoV-2 (COVID-19) pandemic has exacerbated this problem by negatively impacting healthcare systems that have prioritized COVID-19 care over chronic conditions when allocating resources - leading to disruptions in continuity of care for stroke in both high-income and low- and middle-income countries 3 , 4 . To date, most studies on the effects of the COVID-19 pandemic in the field of stroke have focused on the acute management of stroke, specifically measuring reductions in the number of hospitalizations worldwide and the number of procedures conducted 5 , and have not examined continuity of care following discharge.…”

Section: Introductionmentioning

confidence: 99%

Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru

Zafra-Tanaka

Portocarrero

Abanto

et al. 2022

Journal of Stroke and Cerebrovascular Diseases

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Objectives: To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. Methods: A qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients’ journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. Results: We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. Conclusions: The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients’ experiences and feelings by developing solutions in a participatory manner.

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A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

Cited by 18 publications

References 42 publications

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19

Intracerebral hemorrhage during the pandemic- Learning from experience

Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru

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