Delayed Comprehensive Stroke Unit Care Attributable to the Evolution of Infection Protection Measures across Two Consecutive Waves of the COVID-19 Pandemic

Abstract

We aimed to assess how evidence-based stroke care changed over the two waves of the COVID-19 pandemic. We analyzed acute stroke patients admitted to a tertiary care hospital in Germany during the first (2 March 2020–9 June 2020) and second (23 September 2020–31 December 2020, 100 days each) infection waves. Stroke care performance indicators were compared among waves. A 25.2% decline of acute stroke admissions was noted during the second (n = 249) compared with the first (n = 333) wave of the pandemic. Patients were more frequently tested SARS-CoV-2 positive during the second than the first wave (11 (4.4%) vs. 0; p < 0.001). There were no differences in rates of reperfusion therapies (37% vs. 36.5%; p = 1.0) or treatment process times (p > 0.05). However, stroke unit access was more frequently delayed (17 (6.8%) vs. 5 (1.5%); p = 0.001), and hospitalization until inpatient rehabilitation was longer (20 (1, 27) vs. 12 (8, 17) days; p < 0.0001) during the second compared with the first pandemic wave. Clinical severity, stroke etiology, appropriate secondary prevention medication, and discharge disposition were comparable among both waves. Infection control measures may adversely affect access to stroke unit care and extend hospitalization, while performance indicators of hyperacute stroke care seem to be untainted.

Did the severity of the COVID-19 outbreak affect the quality of acute stroke care? (Data from across the country)

“…This is also confirmed by the fact that the country level data in Germany showed a slight increase in the number of patients admitted to hospitals in the second wave in comparison with the first one . 8,10 No difference in the number of stroke patients between the first and the second wave was found in three tertiary care hospitals in Greece, although the severity of the pandemic during the second wave was stronger in Greece. The authors did not note a repeating of the reduction in the number of admissions of younger patients during the second wave, which was observed in the first wave.…”

“…In Germany, there was a decrease in the proportion of patients treated with IVT in the second wave, which was probably due to a reduction in the number of intensive care units but also due to an increase in the total number of patients admitted with acute stroke. 10 In contrast, the use of MT was consistently higher throughout 2020 when compared to 2019, and it is probably part of Germany’s steadily rising MT rate over past years. 8,19,20 An increase in the total number of patients admitted with acute stroke in the second wave of the COVID-19 pandemic was also referred to in the Madrid health region with one endovascular centre and seven hospitals with ISUs (intensive stroke units).…”

“…9 In contrast to our results, the authors from a tertiary care hospital in Saxony, Germany, found a 25% decline in stroke admissions during the second wave period, when Saxony was among the most severely affected regions in Germany, while it was barely affected by the first wave. 10 They explained the drop in the number of stroke admitted patients by the regional variability of SARS-CoV-2 incidence in Germany and by an avoidance to seek hospital treatment during the increasing intensity of lockdown measures. This is also confirmed by the fact that the country level data in Germany showed a slight increase in the number of patients admitted to hospitals in the second wave in comparison with the first one .…”

“…This is also confirmed by the fact that the country level data in Germany showed a slight increase in the number of patients admitted to hospitals in the second wave in comparison with the first one . 8,10…”

Pathophysiology of Cardiac Injury in COVID-19 Patients with Acute Ischaemic Stroke: What Do We Know So Far?—A Review of the Current Literature

“…In addition, existing cardiovascular risk factors such as diabetes, arterial hypertension, a lipid metabolism disorder or nicotine excess can additionally increase the risk of cardiovascular diseases including stroke. As pointed out recently, care of stroke patients is challenging during the COVID-19 pandemic not only because a past history of stroke is a risk factor of severe COVID-19 whereas severe COVID-19 is a risk factor of stroke, forming a vicious circle on a pathophysiological level, but also because infection control measures may impact care of stroke patients [70][71][72][73].…”