Greater decline of acute stroke admissions compared with acute coronary syndromes during COVID‐19 outbreak in Greece: Cerebro/cardiovascular implications amidst a second wave surge

Abstract

Background and purpose: A remarkable decline in admissions for acute stroke and acute coronary syndrome (ACS) has been reported in countries severely hit by the COVID-19 pandemic. However, limited data are available from countries with less COVID-19 burden focusing on concurrent stroke and ACS hospitalisation rates from the same population. Methods:The study was conducted in three geographically and demographically representative COVID-19 referral university hospitals in Greece. We recorded the rate of stroke and ACS hospital admissions during a 6-week period of the COVID-19 outbreak in 2020 and compared them with the rates of the corresponding period in 2019. Results: We found a greater relative reduction of stroke admissions (51% [35 vs. 71]; incidence rate ratio [IRR]: 0.49, p = 0.001) compared with ACS admissions (27% [123 vs. 168]; IRR: 0.73, p = 0.009) during the COVID-19 outbreak (p = 0.097). Fewer older (>65 years) patients (stroke: 34.3% vs. 45.1%, odds ratio [OR]: 0.64, p = 0.291; ACS: 39.8% vs. 54.2%, OR: 0.56, p = 0.016) were admitted during the COVID-19 compared with the control period.Conclusions: Hospitalisation rates both for stroke and ACS were reduced during the COVID-19 outbreak in a country with strict social distancing measures, low COVID-19 incidence and low population mortality. Lack of triggers for stroke and ACS during social distancing/quarantining may explain these observations. However, medical care avoidance attitudes among cerebro/cardiovascular patients should be dissipated amidst the rising second COVID-19 wave.

Persistent decline of hospitalizations for acute stroke and acute coronary syndrome during the second wave of the COVID-19 pandemic in Greece: collateral damage unaffected

“…Using identical methodology, we have previously reported a greater reduction of AS (51%) compared with ACS admissions (27%) during the first wave of the COVID-19 pandemic and the first national lockdown in Greece. 10 The relative reduction of ischaemic stroke admissions was 47% and of haemorrhagic stroke admissions 69%. There was a similar relative reduction for STEMI and NSTEMI/UA admissions (26% versus 27%, respectively).…”

“…We conducted an observational study including patients admitted with AS or ACS to three tertiary care university hospitals of different geographic and epidemiologic regions of Greece (southern: Athens; northern: Thessaloniki; western: Ioannina). 10 The methodology of our study has previously been published. 10 In brief, all consecutive patients who were admitted with a confirmed diagnosis of AS or ACS were included in this study.…”

“… 10 The methodology of our study has previously been published. 10 In brief, all consecutive patients who were admitted with a confirmed diagnosis of AS or ACS were included in this study. Stroke patients were categorized in acute ischaemic stroke and acute haemorrhagic stroke subgroups.…”

“…Moreover, many national authorities instituted lockdowns (mandatory to stay at home, work from home, school closures and business closure orders) to slow the rapid spread of the virus. At the same time, numerous regional and national reports suggested a significant decline in acute stroke (AS) 2 – 11 and acute coronary syndrome (ACS) admissions. 12 – 16 Therefore, strict social measures and fear of exposure to SARS-CoV-2 could have inadvertently discouraged patients from seeking medical care.…”

Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown

“…Understanding the impact of state-wide lockdown measures on acute stroke care is crucial to improving healthcare systems' coordination during public health emergencies. There are currently few studies evaluating stroke care in low COVID-19 incidence settings [17,18] and no studies addressing the impact on prehospital stroke triage.…”