Quality in stroke care during the early phases of the COVID-19 pandemic: A nationwide study

Abstract

Introduction: Evidence-based early stroke care as reflected by fulfillment of process performance measures, is strongly related to better patient outcomes after stroke and transient ischemic attack (TIA). Detailed data on the resilience of stroke care services during the COVID-19 pandemic are limited. We aimed to examine the quality of early stroke care at Danish hospitals during the early phases of the COVID-19 pandemic. Materials and methods: We extracted data from Danish national health registries in five time periods (11 March, 2020–27 January, 2021) and compared these to a baseline pre-pandemic period (13 March, 2019–10 March, 2020). Quality of early stroke care was assessed as fulfilment of individual process performance measures and as a composite measure (opportunity-based score). Results: A total of 23,054 patients were admitted with stroke and 8153 with a TIA diagnosis in the entire period. On a national level, the opportunity-based score (95% confidence interval [CI]) at baseline for ischemic patients was 81.1% (80.8–81.4), for intracerebral hemorrhage (ICH) 85.5% (84.3–86.6), and for TIA 96.0% (95.3–96.1). An increase of 1.1% (0.1–2.2) and 1.5% (0.3–2.7) in the opportunity-based score was observed during the first national lockdown period for AIS and TIA followed by a decline of −1.3% (−2.2 to −0.4) in the gradual reopening phase for AIS indicators. We found a significant negative association between regional incidence rates and quality-of-care in ischemic stroke patients implying that quality decreases when admission rates increase. Conclusion: The quality of acute stroke/TIA care in Denmark remained high during the early phases of the pandemic and only minor fluctuations occurred.

Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark

“…Knowledge on coronavirus infection status on a patient level did not influence care and the fulfilment of quality measures for patients with AIS admitted to a stroke unit. This is in line with previous results from a study on data from the DSR showing that the overall quality of care during the pandemic remained high 12. Similar studies from other countries, including the USA and UK, also found that quality in stroke care was maintained and for some domains even improved 26 27.…”

“…Information on 30-day mortality was obtained from the Danish Civil Registration System and information on quality of care was obtained from the DSR using the registered stroke care performance measures covering acute and prophylactic treatment, carotid vessel imaging and early rehabilitation. For each patient, we calculated an opportunity-based score defined as the number of fulfilled performance measures divided by the number of relevant performance measures as well as an all or no score, with a score of 1 if all relevant performance measures were met and a score of 0 if not all relevant measures were met 12 22. Mortality was all-cause mortality with information on vital status obtained from the Danish Civil Registration System.…”

“…Previously, data from Danish national registers have shown that the overall quality of acute stroke care remained high with only minor fluctuations during the COVID-19 pandemic. 12 At the same time, stroke admission rates remained largely unchanged. 13 In the present study, we aimed to investigate the prevalence of positive coronavirus tests among patients with AIS in Denmark and whether SARS-CoV-2 status had an impact on stroke severity, quality of care and mortality.…”

“…Previously, data from Danish national registers have shown that the overall quality of acute stroke care remained high with only minor fluctuations during the COVID-19 pandemic 12. At the same time, stroke admission rates remained largely unchanged 13.…”

Stressed systems: Stroke unit bed occupancy and impact on reperfusion therapy in acute ischemic stroke

“…Marginal cases with an atypical presentation, or premorbid nonindependent patients, may make stroke physicians direct patients to an emergency department instead of a stroke unit. The COVID-19 pandemic did affect stroke care in some countries, but based on earlier performed analysis indicating no effect on admission, reperfusion therapy rates, and quality of acute stroke care, it is unlikely that the pandemic affected the results of the current study (15,16).…”