Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain

Meza, H. Tejada; Gil, Á. Lambea; Saldaña, A. Sancho; Martínez-Zabaleta, Maite; Juez, Patricia de la Riva; Martínez, Esther; Apilánez, María Castañón; Isasi, M. Herrera; Marta-Enguita, Juan; Alfonso, Mercedes de Lera; Arenillas-Lara, Juan Francisco; Olaizola, Jon Segurola; Fernández, Juan José Timiraos; Sánchez, Joaquín; Castellanos-Rodrigo, Mar; Roel, Alexia; Menéndez, Ignacio Casado; Freijo, Mar; Rodriguez, A.; Portilla, Enrique Palacio; López, Yesica; Rodríguez‐Castro, Emilio; Rivas, Susana; García, J. Tejada; Rodríguez, Iria Beltrán; Julián‐Villaverde, F.; García, Maria Pilar Moreno; Trejo-Gabriel-Galán, J.M.; Íñiguez, Ana Echavarría; Juste, C. Tejero; Lázaro, Cristina Pérez; Moreno, J. Marta; Investigators, on behalf of the NORDICTUS

doi:10.1177/1747493020938301

Cited by 72 publications

(83 citation statements)

References 9 publications

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“…We performed a retrospective study using our institutional stroke registry to investigate pre- and intra-hospital delays during the COVID period. We then compared our institutional data to the Get with the Guidelines (GWTG) database to analyze our experience by comparing regional and national trends in stroke volume [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of the COVID-19 Pandemic on Stroke Patients

Ghanchi¹,

Takayanagi²,

Savla³

et al. 2020

Cureus

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Introduction The severe acute respiratory syndrome coronavirus 2 (SARS2-CoV-2) induced pandemic (COVID-19 pandemic) has affected healthcare in all aspects, including stroke care. We sought to investigate this effect with analysis of our hospital’s stroke treatment protocols as well as stroke volume on state, regional, and national levels. Methods This was a retrospective review of prospectively collected data from our stroke registry to assess the impact of the SARS2-CoV-2 induced pandemic on the volume of stroke patients presenting to our facility. Demographics collected included age, sex, race, National Institute of Health Stroke Scale (NIHSS) on admission, discharge modified Rankin Score (mRS), type of stroke (ischemic, hemorrhagic, or transient ischemic attack), time of symptom onset, and time to initial imaging. Data were also stratified by date and comparison was made between the intra-COVID-period (March and April 2020), pre-COVID period (March and April 2019), and peri-COVID period (January and February 2020). To determine stroke trends on a national level, we utilized the Get with the Guidelines (GWTG) stroke database to compare stroke volumes in the pre-COVID, peri-COVID, and intra-COVID periods between our hospital, all California hospitals, and the West and Pacific regions. Results There was a significant increase in last known well time (LKWT) to arrival to the emergency department (ED) (LKWT to door) as well as time from arrival to the ED to obtaining a computed tomography (CT) of the head (door to CT) in March 2020 compared to 2019 (p=0.0220 and p=0.0475, respectively). There were significantly fewer transient ischemic attacks (TIAs) in California hospitals as well as in March and April 2020 in comparison to January and February 2020 (p=0.0417). Similarly, there were significantly fewer TIAs in March and April 2019 compared to March and April 2020 (p=0.0360). The decrease in TIAs was also seen at our hospital in both time frame comparisons as well as in West Regional Hospitals in March and April 2020 compared to March and April 2019 (p=0.0111, p=0.0215, and p=0.0414, respectively). Conclusion Stroke care has been disrupted by the COVID-19 pandemic worldwide. We identified a delay in LKWT to door as well as time from door to CT in March 2020 compared to March 2019 at our institution. There was a statistically significant decrease in final diagnosis of TIA at our hospital, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic. Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic.

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Section: Introductionmentioning

confidence: 99%

Effects of the COVID-19 Pandemic on Stroke Patients

Ghanchi¹,

Takayanagi²,

Savla³

et al. 2020

Cureus

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“…Interestingly, despite a reduction in the number of hospital admissions for AIS, a higher proportion of patients received reperfusion therapies compared to both pre-COVID-19 era in 2020 and from the same period in 2019. However, previous reports have shown a decreased number [21] , [22] , [23] but a relatively unchanged proportion 6 , 18 of patients who received reperfusion therapy during COVID-19 pandemic. The first confirmed case in Virginia was reported on March 7, 2020, and the first confirmed case was admitted to our facility on March 12, 2020.…”

Section: Discussionmentioning

confidence: 90%

“…The impact of the COVID-19 pandemic on hospital admissions for vascular diseases, including acute coronary syndrome [14] , [15] and acute ischemic stroke, 6 , [15] , [16] , [17] , [18] , [19] , [20] has been reported. A 36.4% reduction in AIS admissions was seen in Brazil after COVID-19 compared to the same period in 2019.…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on acute ischemic stroke admissions: Analysis from a community-based tertiary care center

Wang

Chaudhry

Tahsili-Fahadan

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Background/Objective To evaluate the impact of the COVID-19 pandemic on hospital admissions and outcomes in patients admitted with acute ischemic stroke. Methods Single-center retrospective analysis of patients admitted to the hospital with acute ischemic stroke, between December 1 st , 2019 and June 30 th ,2020. Outcomes were classified as none-to-minimal disability, moderate-to-severe disability, and death based on discharge disposition, and compared between two time periods: pre-COVID-19 era (December 1 st , 2019 to March 11 th , 2020) and COVID-19 era (March 12 th to June 30 th , 2020). We also performed a comparative trend analysis for the equivalent period between 2019 and 2020. Results Five hundred and seventy-five patients with a mean age (years±SD) of 68 ±16 were admitted from December 1 st , 2019 to June 30 th , 2020, with a clinical diagnosis of acute ischemic stroke. Of these, 255 (44.3%) patients were admitted during the COVID-19 era. We observed a 22.1% and 39.5% decline in admission for acute ischemic stroke in April and May 2020, respectively. A significantly higher percentage of patients with acute ischemic stroke received intravenous thrombolysis during the COVID-19 era (p=0.020). In patients with confirmed COVID-19, we found a higher percentage of older men with preexisting comorbidities such as hyperlipidemia, coronary artery disease, and diabetes mellitus but a lower rate of atrial fibrillation. In addition, we found a treatment delay in both intravenous thrombolysis (median 94.5 min versus 38 min) and mechanical thrombectomy (median 244 min versus 86 min) in patients with confirmed COVID-19 infection. There were no differences in patients’ disposition including home, short-term, and long-term facility (p=0.60). Conclusions We observed a reduction of hospital admissions in acute ischemic strokes and some delay in reperfusion therapy during the COVID-19 pandemic. Prospective studies and a larger dataset analysis are warranted.

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“…On the contrary, health authorities emphasised that suspected stroke victims should continue to seek medical attention and call the emergency medical services despite the lockdown. There are contradicting results regarding prehospital delay and the overall number and proportion of ischemic stroke patients receiving intravenous thrombolysis during the lockdown [ 1 , 2 , 5 , 7 , 8 , 10 – 13 ] and reduced standard of care and delayed stroke care pathways with increased door-to-needle time have also been reported [ 1 , 2 , 5 , 7 , 8 , 10 – 13 ]. The proportion receiving thrombolysis if they reached our hospital within the time window was similar for all three periods, indicating that the hospital’s acute stroke workflow and pathway were not affected to a degree harming patients [ 10 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Stroke admission rates before, during and after the first phase of the COVID-19 pandemic

et al. 2021

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Background There was a significant decrease in stroke admissions during the first phase of the COVID-19 pandemic. There are concerns that stroke patients have not sought medical attention and in the months after the lockdown suffer recurrent severe strokes. The aims of this study were to investigate how stroke admission rates and distributions of severity varied before, during and after the lockdown in a representative Norwegian hospital population. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke from January to September 2020 were identified by hospital chart review. Results We observed a transient decrease in weekly stroke admissions during lockdown from an average of 21.4 (SD 4.7) before to 15.0 (SD 4.2) during and 17.2 (SD 3.3) after (p < 0.011). The proportion of mild ischemic and haemorrhagic strokes was also lower during lockdown with 66% before, 57% during and 68% after (p = 0.011). Conclusion The period of COVID-19 lockdown was associated with a temporary reduction in total admissions of strokes. In particular, there were fewer with TIA and mild stroke. Given the need to prevent the worsening of symptoms and risk of recurrence, it is necessary to emphasise the importance to seek medical care even in states of emergency.

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Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain

Cited by 72 publications

References 9 publications

Effects of the COVID-19 Pandemic on Stroke Patients

Effects of the COVID-19 Pandemic on Stroke Patients

The impact of COVID-19 on acute ischemic stroke admissions: Analysis from a community-based tertiary care center

Stroke admission rates before, during and after the first phase of the COVID-19 pandemic

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