Impact of COVID-19 on ischemic stroke care in Hungary

Abstract

Data about the coronavirus disease 2019 (COVID-19) pandemic’s collateral damage on ischemic stroke (IS) care during the second epidemic wave in Central Europe are limited. We sought to evaluate the impact of the COVID-19 outbreak on Hungarian IS care during the two epidemic waves. This retrospective observational study was based on a nationwide reimbursement database that encompasses all IS admissions and all reperfusion interventions, i.e., intravenous thrombolysis (IVT) and endovascular therapy (EVT) from 2 January 2017 to 31 December 2020 in Hungary. COVID-19 pandemic’s effect on the number of IS admissions and reperfusion interventions were analyzed using different statistics: means, medians, trends, relative rates, and linear relationships. The mean and median values of IS admissions and reperfusion interventions decreased only in some measure during the COVID-periods. However, trend analysis demonstrated a significant decline from the trends. The decline’s dynamic and amplitude have differed for each variable. In contrast to IVT, the number of IS admissions and EVTs negatively correlated with the epidemic waves’ amplitude. Besides, the decrease in the number of IS admissions was more pronounced than the decrease in the number of reperfusion interventions. Our study demonstrated a significant disruption in IS care during the COVID-19 epidemic in Hungary, in which multiple different factors might play a role. The disproportionate reduction of IS admission numbers could partially be explained by the effect of health emergency operative measures and changes in patients’ social behavior. Further studies are needed to evaluate the causes of our observations.

Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic

“… 8 A study from Hungary demonstrated that both intravenous thrombolysis and endovascular therapy rates declined, but that the specific temporal pattern in these stroke therapies fluctuated over surges in the pandemic. 34 A study from the United Kingdom indicated that quality of care was preserved during the pandemic. 32 Our results are similar to those from a study of stroke care quality in Taiwan that also reported higher quality rates during the COVID-19 pandemic as compared to the pre-COVID-19 period.…”

The impact of SARS-CoV-2 infection on the outcome of acute ischemic stroke—A retrospective cohort study

“…There has been a noticeable drop in acute stroke hospitalization and acute reperfusion therapy numbers during the pandemic worldwide [ 33 , 35 , 45 – 51 ] as well as in Hungary [ 52 , 53 ]. In the COVID-19 pandemic era, it is a struggle to harmonize the obligatory containment restrictions for COVID-19 and the “time is brain” concept of acute reperfusion.…”

Stringent public health measures during COVID-19 across ischemic stroke care systems: the potential impact of patient perceptions on health care-seeking behaviors

“…Inspired by the analysis from Bojti et al [ 20 ], we examined if similar situations occurred at two distinct medical institutions in the USA: Northwestern Memorial Hospital Comprehensive Stroke Center, Chicago, IL, and Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK. For the first institution, raw data was converted to standardized z -scores to compare across periods, as done by Bojti et al We considered z -scores of magnitude 2 or greater to represent statistically significant deviations in case numbers at a given time point relative to the entire time period of comparison. For the second institution, we used the Mann–Kendall test for monotonic trend, with significance set at 0.05.…”

“…After the first wave of COVID-19 (spring 2020) subsided in various regions around the world, these anecdotal reports of reduced acute presentations for stroke were confirmed by multiple separate groups [ 15 – 19 ]. The recent publication by Bojti et al [ 20 ] in Geroscience is unique among these reports in that they provide additional insight by presenting specific data from several years of pre-pandemic acute stroke admissions, cases from multiple consecutive COVID-19 waves, and corresponding public health mandates that were implemented in an effort to mitigate COVID-19 associated morbidity. The national scope of these data suggests that the study results and potential public health lessons are likely to generalize to similar socioeconomic settings outside of Hungary, where Bojti et al [ 20 ] conducted their study.…”

“…By using control data dating back to 2017 to establish trends and weekly case counts expressed as z -scores (a standardized measure equivalent to the number of standard deviations a given week’s case numbers are from the overall study period mean), Bojti et al demonstrated that ischemic stroke admissions, intravenous thrombolysis cases, and endovascular therapy cases experienced a significant negative deviation during the first and second COVID-19 waves in Hungary [ 20 ]. However, the ratio of both intravenous thrombolysis administrations to ischemic stroke admissions and endovascular interventions to ischemic stroke admissions actually significantly increased during both of Hungary’s COVID-19 waves, suggesting that the decline in ischemic stroke admissions was disproportionately greater than the decline in acute revascularization therapies.…”