Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Srivastava, Pratyaksh K.; Zhang, Shuaiqi; Xian, Ying; Xu, Hanzhang; Rutan, Christine; Alger, Heather M.; Walchok, Jason; Williams, Joseph; Lemos, James A. de; Decker‐Palmer, Marquita; Elkind, Mitchell S.V.; Messé, Steve R.; Smith, Eric E.; Schwamm, Lee H; Fonarow, Gregg C.

doi:10.1161/strokeaha.120.034414

Cited by 24 publications

(31 citation statements)

References 31 publications

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“…According to this finding, a similar proportion of cases with minor symptoms were hospitalized during the COVID-19 lockdowns. This is in accordance with the analysis of U.S. national inpatient stroke registry data on 81,084 patients with acute ischemic stroke who showed decreased hospitalizations and consistent median NIHSS scores during COVID-19 (4 February 2020 to 29 June 2020) compared to pre-pandemic period (1 November 2019 to 3 February 2020) ( 3 ). In contrast, an analysis of German health claims data found that patients with cerebral infarction or intracerebral hemorrhage more frequently suffered from hemiparesis or hemiplegia, speech impairment, swallowing difficulties, and hemispatial neglect ( 6 ).…”

Section: Discussionsupporting

confidence: 87%

“…In the months following the onset of the SARS-CoV-2 pandemic (COVID-19), a decrease in the number of patients with stroke admitted to hospitals was observed in several countries ( 1 , 2 ), which raised concerns about delays in adequate diagnosis and treatment of patients with stroke. Evaluation of a U.S. national inpatient stroke registry indicates a decline of acute ischemic stroke presentations of 15.3% in the period from the first week of February to the fourth week of June in 2020 when compared to the same weeks in 2019 ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Stroke care during the COVID-19 pandemic: Case numbers, treatments, and mortality in two large German stroke registries

et al. 2022

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Background and purposeAt the beginning of the SARS-CoV-2 pandemic, an alarming decline in hospitalizations for stroke was reported in several countries, including Germany. We assessed hospitalization numbers and indicators of the quality of stroke care in 2020 during the pandemic containment measures.Materials and methodsThe analysis was based on data of two large stroke quality assurance registries in the north and the south of Germany (Qualitätssicherung Schlaganfall Nordwestdeutschland and Bayerische Arbeitsgemeinschaft für Qualitätssicherung in der stationären Versorgung) were used for quality assurance in the north and south of Germany. We included 395 hospitals with 467,931 documented cases in 2018–2020. The time interval between admission and thrombolysis, frequency of systemic thrombolysis and intra-arterial therapy (IAT), National Institutes of Health Stroke Scale (NIHSS) score on admission and in-hospital mortality were assessed. Changes in the second (Q2) and fourth (Q4) quarters of 2020 were compared to corresponding quarters in 2019 by chi-squared tests.ResultsHospitalization numbers decreased in the two stroke registries by 8% and 10% in Q2 of 2020 and by 5% and 15% in Q4 of 2020 compared to the same quarters in 2019, respectively. The decline was particularly seen in women and patients with transient ischemic attacks. In cases with cerebral infarction, no increase in NIHSS scores on admission was observed, and the proportion of patients with a time interval between admission and thrombolysis of ≤60 min was unchanged. No clear pattern was found in the frequency of systemic thrombolysis and IAT. In one of the registries, in-hospital mortality of patients with cerebral infarction increased in Q2 of 2020 compared to Q2 of 2019.ConclusionCase numbers slightly decreased under pandemic conditions, while our quarterly analysis indicated that the quality of stroke care was largely unchanged throughout the year 2020.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Stroke care during the COVID-19 pandemic: Case numbers, treatments, and mortality in two large German stroke registries

et al. 2022

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“…However, overall, large studies show that there is similar door-to-CT, door-to-needle, and door-to-endovascular therapy times in the pre-COVID-19 era compared with the COVID-19 era. Additionally, there were no significant differences in the proportion of patients who received intravenous thrombolysis or endovascular therapy [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Primary and secondary stroke prevention guidelines should be implemented, and early rehabilitation should be started in the isolation area if feasible [ 32 ]. There have been reports of decreases in prescription of antithrombotics at discharge, dysphagia screening, smoking cessation counseling, stroke education, and rehabilitation consideration in COVID-19 and acute CVD patients [ 33 ]. It is important to remember the established practices in treating acute CVD, even in a complicated COVID-19 patient.…”

Section: Discussionmentioning

confidence: 99%

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The Spectrum of Acute Cerebrovascular Disease in Patients with COVID-19

et al. 2022

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(1) Background: COVID-19 infection is responsible for the ongoing pandemic and acute cerebrovascular disease (CVD) has been observed in COVID-19 patients. (2) Methods: We conducted a retrospective, observational study of hospitalized adult patients admitted to our hospital with SARS-CoV-2 and acute cerebrovascular disease. All clinical data were reviewed including epidemiology, clinical features, laboratory data, neuroradiological findings, hospital management and course from 32 patients hospitalized for COVID-19 management with acute cerebrovascular disease. (3) Results: Acute CVD with COVID-19 was associated with higher NIH stroke scale on discharge compared to non-COVID-19 CVDs. Seizures complicated the hospital course in 16% of COVID-19 patients with CVD. The majority of the acute CVDs were ischemic (81%) in nature followed by hemorrhagic (22%). Acute CVD with COVID-19 resulted in average hospital stays greater than twice that of the control group (13 days in COVID-19, 5 days in control). Acute CVD with COVID-19 patients had worse clinical outcomes with 31% patient deaths and 6% discharged to hospice. In the control group, 6% of patients died. (4) Conclusions: Acute CVD associated with COVID-19 tends to be more complicated with unique and adverse clinical phenotype, longer hospital admissions, and worse clinical outcomes.

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Trends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021

Man,

Solomon,

Mac Grory

et al. 2024

JAMA Netw Open

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ImportanceUnderstanding is needed of racial and ethnic–specific trends in care quality and outcomes associated with the US nationwide quality initiative Target: Stroke (TS) in targeting thrombolysis treatment for acute ischemic stroke.ObjectiveTo examine whether the TS quality initiative was associated with improvement in thrombolysis metrics and outcomes across racial and ethnic groups.Design, Setting, and ParticipantsThis retrospective cohort study included patients who presented within 4.5 hours of ischemic stroke onset at hospitals participating in the Get With The Guidelines–Stroke initiative from January 1, 2003, to December 31, 2021. The data analysis was performed between December 15, 2022, and November 27, 2023.ExposuresTS phases I (2010-2013), II (2014-2018), and III (2019-2021).Main Outcomes and MeasuresThe primary outcomes were thrombolysis rates and time metrics. Patient function and mortality were secondary outcomes.ResultsAnalyses included 1 189 234 patients, of whom 1 053 539 arrived to the hospital within 4.5 hours. The cohort included 50.4% female and 49.6% male patients and 2.8% Asian [median (IQR) age, 72 (61-82) years], 15.2% Black [median (IQR) age, 64 (54-75) years], 7.3% Hispanic [median (IQR) age, 68 (56-79) years], and 74.1% White [median (IQR) age, 75 (63-84) years] patients). Unadjusted thrombolysis rates increased in both the pre-TS (2003-2009) and TS periods in all racial and ethnic groups from 10% to 15% in 2003 to 43% to 46% in 2021, but disparities were observed in adjusted analyses and persisted in TS phase III, with Asian, Black, and Hispanic patients having significantly lower odds of receiving thrombolysis than White patients (adjusted odds ratio, 0.85 [95% CI, 0.81-0.90], 0.76 [95% CI, 0.74-0.78], and 0.86 [95% CI, 0.83-0.89], respectively). Door-to-needle (DTN) times improved in all racial and ethnic groups during TS, with DTN times of 60 minutes or less increasing from 26% to 28% in 2009 to 66% to 72% in 2021. However, in adjusted analyses, racial and ethnic disparities emerged. During TS phase III, compared with White patients, Asian, Black, and Hispanic patients had significantly lower odds of receiving thrombolysis with a DTN time of 60 minutes or less compared with White patients (risk-adjusted odds ratios, 0.91 [95% CI, 0.84-0.98], 0.78 [95% CI, 0.75-0.81], and 0.87 [95% CI, 0.83-0.92], respectively). During TS, clinical outcomes improved for all racial and ethnic groups from pre-TS, with TS phase III showing higher odds of ambulation at discharge among Asian, Black, Hispanic, and White patients. Asian, Black, and Hispanic patients were less likely to present within 4.5 hours.Conclusions and RelevanceIn this cohort study of patients with ischemic stroke, the TS quality initiative was associated with improvement in thrombolysis frequency, timeliness, and outcomes for all racial and ethnic groups. However, disparities persisted, indicating a need for further interventions.

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Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Cited by 24 publications

References 31 publications

Stroke care during the COVID-19 pandemic: Case numbers, treatments, and mortality in two large German stroke registries

Stroke care during the COVID-19 pandemic: Case numbers, treatments, and mortality in two large German stroke registries

The Spectrum of Acute Cerebrovascular Disease in Patients with COVID-19

Trends in Stroke Thrombolysis Care Metrics and Outcomes by Race and Ethnicity, 2003-2021

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