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

Abstract

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.

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

“…Most studies compared the pandemic period (ranging from January to June 2020) to a similar period in the preceding year (range January to June 2019) [28][29][30][31]33,35,39,[41][42][43]45,46,[48][49][50]52,[54][55][56][57][58]60 or the months preceding the pandemic (range September 2019 to December 2019). 8,32,34,[36][37][38]40,44,47,51,53,59,[61][62][63]…”

Impact of the COVID‐19 pandemic and a national lockdown on hospitalizations for stroke and related 30‐day mortality in France: A nationwide observational study

“…As data on IVT were not available exhaustively, they were not analysed in our study. This should be addressed in future studies to explore the lower rates of IVT reported in local stroke centres in France [31] and abroad [6,28], and the delay in administering endovascular treatments [4,6,28,33].…”

“…hospitalized for stroke during the COVID-19 pandemic have been described in local areas of France as well as in other countries [1,[3][4][5][6][7][8][9][10][11][12][13][14]. However, the magnitude of this decrease differed among countries, with only a limited decline in stroke admissions in Germany [15] compared with a 39% reduction in the United States [3,4] and a 60% reduction in the Veneto region of Italy [12,16].…”

“…hospitalized for stroke during the COVID-19 pandemic have been described in local areas of France as well as in other countries [1,[3][4][5][6][7][8][9][10][11][12][13][14]. However, the magnitude of this decrease differed among countries, with only a limited decline in stroke admissions in Germany [15] compared with a 39% reduction in the United States [3,4] and a 60% reduction in the Veneto region of Italy [12,16]. By contrast, a study conducted in Brescia, Italy, reported similar rates of stroke admissions and even a higher rate of ischemic stroke admissions during the months of March and April 2020 compared to previous years [17].…”

Systemic thrombolysis in ischaemic stroke patients with COVID‐19

“…Intravenous thrombolysis (IVT) with the use of recombinant tissue plasminogen activator is an effective and universally recommended method of treatment in the acute ischaemic stroke (AIS) 5,6 . Unfortunately, COVID‐19 resulted in a global decline in the volume of stroke hospitalizations and IVT treatments 7‐10 11 and pneumonia especially predicts increasing mortality in these patients 12 .…”