Stroke management during the COVID-19 outbreak: challenges and results of a hub-center in Lombardy, Italy

Asteggiano, Francesco; Divenuto, Ignazio; Ajello, Daniele; Gennaro, Nicolò; Santonocito, Orazio Giuseppe; Marcheselli, Simona; Balzarini, Luca; Nuzzi, Nunzio Paolo; Politi, Letterio S.

doi:10.1007/s00234-020-02617-3

Cited by 6 publications

(10 citation statements)

References 14 publications

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“…On average a total increase of the global time from the onset of symptoms to Balloon is around 3 hours and 41 mins (statistically significant at a 5% confidence level) in line with recent study at Humanitas Hospital in Lombardy (see Asteggiano et al, 2021).…”

Section: Resultssupporting

confidence: 89%

The impact of COVID-19 pandemic on AMI and Stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

Rossi

Berta²,

Curello

et al. 2021

Preprint

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Background: The Covid-19 pandemic has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world for both Covid and no-Covid patients. In this context, it is extremely important to assess whether the clinical management of no-Covid cases has not seriously been compromised during the first epidemic outbreak. Among no-Covid cases, patients with acute myocardial infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates as no-Covid patients to be studied. Preliminary evidence suggests that i) the time from onset of symptoms to emergency department (ED) presentation has increased in Covid-19 times as well 30-day mortality during the pandemic has been higher. We aimed to complement this evidence assessing if the additional stress due to the high inflow of Covid-19 patients at hospital level has modified AMI and Stroke admission criteria and related mortality rates in a causal inference framework. Methods: To study the impact of Covid pandemic on mortality rates for AMI and Stroke we adopt two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs by which we identify the plausible causal effect on mortality of the Covid-19-related hospital stress due to the introduction of State of Emergency restrictions. Findings: We check the causal effect of the Covid-19 pandemic on mortality rates of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9th). Despite the potential adverse effect on expected mortality due to a longer time to hospitalization, the AMI and Stroke mortality rates are overall not statistically different from the one observed in the control group. The obtained results provided by RDD and DRD models are robust also when we account for seasonality and unobserved factors. Interpretation: In a quasi-experimental setting we assessed the causal impact of the hospital and staff extra-burden generated by the first wave of Covid-19 patients on mortality rates of no-Covid non-deferrable urgent cases (AMI and Stroke) hospitalized at Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. We find a non-statistically significant impact on mortality rates for AMI and Stroke patients providing evidence of the hospital ability to manage -with the implementation of a double track organization- the simultaneously delivery of high quality cares to both Covid and no-Covid patients. Availability of similar data for the regional context as a whole is needed to further substantiate the findings and explore existing differences in efficacy of different managerial settings implemented in Lombardy hospitals.

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Section: Resultssupporting

confidence: 89%

The impact of COVID-19 pandemic on AMI and Stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

Rossi

Berta²,

Curello

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Our estimates (onset of symptoms to Balloon) is in line with recent studies regarding Humanitas hospital in Lombardy [30].…”

Section: Plos Onesupporting

confidence: 91%

“…To complement the previous analyses, we also examine times from the onset of patients' symptoms to door and to balloon. In this end, it is important to note that -as pointed out in some recent contributions in the literature-Lombardy region has experienced -on average-an increase in the time from the onset of the first symptoms to the patients hospitalization during the pandemic and we know from the literature how early recognition of symptoms along with shorten time to intervention usually results in better outcomes following both stroke and AMI ( [28][29][30]).…”

Section: Methodsmentioning

confidence: 98%

The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

et al. 2021

View full text Add to dashboard Cite

Background The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied. Preliminary evidence suggests that the time from onset of symptoms to emergency department (ED) presentation has significantly increased in Covid-19 times as well as the 30-day mortality and in-hospital mortality. Methods We check, in a causal inference framework, the causal effect of the hospital’s stress generated by Covid-19 pandemic on in-hospital mortality rates (primary end-point of the study) of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9th 2020) using two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs. Data are drawn from Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. Findings Despite the potential adverse effects on expected mortality due to a longer time to hospitalization and staff extra-burden generated by the first wave of Covid-19, the AMI and stroke mortality rates are overall not statistically different during the first wave of Covid-19 than before the first peak. The obtained results provided by RDD models are robust also when we account for seasonality and unobserved factors with DRD models. Interpretation The non-statistically significant impact on mortality rates for AMI and stroke patients provides evidence of the hospital ability to manage -with the implementation of a dual track organization- the simultaneous delivery of high-quality cares to both Covid and non-Covid patients.

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“…The reorganization of healthcare resources, reallocation of stroke professionals, and the prioritization of COVID-19 patients 59 led to changes in stroke care pathways, delays in acute treatment 75 , and consequences for stroke outcomes 76 . Ambulance services experienced an excessive burden due to the pandemic 58 . There was also an increase in the demand for computed tomography (CT) scans 100 ; discontinuation of rehabilitation programs due to the reorganization of resources; shortfalls in health insurance coverage for stroke patients; and limited access to specialized care units and diminished workforce in hospitals 59,68,74,102 .…”

Section: Resultsmentioning

confidence: 99%

Navigating stroke care during the COVID-19 pandemic: A scoping review

Ménard,

Yang,

Oostlander

et al. 2024

Preprint

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BackgroundPrevious viral outbreaks have highlighted implications for the management of complex health conditions. This study delves into the repercussions of the COVID-19 pandemic on stroke care, by examining evidence of shifts in healthcare utilization, the enduring effects on post-stroke recovery, and the overall quality of life experienced by stroke survivors.MethodsA scoping review was conducted following the Joanna Briggs Institute Methodology for Scoping Reviews. The search strategy encompassed electronic databases (APA PsycInfo, Embase, Medline, and CINAHL). English language articles published between December 2019 and January 2022 were included, focusing on individuals who experienced a stroke during the COVID-19 pandemic. Data extraction involved identifying study characteristics and significant findings, facilitating a qualitative and narrative synthesis of the gathered evidence.ResultsSeven domain summaries were identified. They all described the aspects of systemic transformations in stroke care during the COVID-19 pandemic: (1) patient behavior and awareness; (2) telemedicine and remote care; (3) delays in treatment; (4) impact on healthcare resources; (5) quality of care; (6) changes in stroke severity; and (7) reduction in stroke admissions.ConclusionsThis study underscored the critical need to encourage swift patient response to acute stroke symptoms, by finding new avenues for treatment, mitigating hospital-related infection fears, and advocating for the establishment of centralized stroke centers. These measures are integral to optimizing stroke care delivery and ensuring timely interventions, particularly in the challenging context of a pandemic.

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Stroke management during the COVID-19 outbreak: challenges and results of a hub-center in Lombardy, Italy

Cited by 6 publications

References 14 publications

The impact of COVID-19 pandemic on AMI and Stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

The impact of COVID-19 pandemic on AMI and Stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic

Navigating stroke care during the COVID-19 pandemic: A scoping review

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