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

Jing Wang; Saqib A Chaudhry; Pouya Tahsili-Fahadan; Laith R Altaweel; Sairah Bashir; Zelalem Bahiru; Yun Fang; Adnan I Qureshi

doi:10.1016/j.jstrokecerebrovasdis.2020.105344

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

J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105344. doi: 10.1016/j.jstrokecerebrovasdis.2020.105344. Epub 2020 Sep 25.

Authors

Jing Wang¹, Saqib A Chaudhry², Pouya Tahsili-Fahadan³, Laith R Altaweel¹, Sairah Bashir⁴, Zelalem Bahiru⁵, Yun Fang⁶, Adnan I Qureshi⁷

Affiliations

¹ Neuroscience Intensive Care Unit, Department of Medicine, INOVA Fairfax Medical Campus, Falls Church, VA, USA; Neuroscience Research, Neuroscience and Spine Institute, INOVA Fairfax Medical Campus, Falls Church, VA, USA.
² Neuroscience Intensive Care Unit, Department of Medicine, INOVA Fairfax Medical Campus, Falls Church, VA, USA; Neuroscience Research, Neuroscience and Spine Institute, INOVA Fairfax Medical Campus, Falls Church, VA, USA. Electronic address: Saqib.Chaudhry@inova.org.
³ Neuroscience Intensive Care Unit, Department of Medicine, INOVA Fairfax Medical Campus, Falls Church, VA, USA; Neuroscience Research, Neuroscience and Spine Institute, INOVA Fairfax Medical Campus, Falls Church, VA, USA; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Neurology, INOVA Fairfax Medical Campus, Falls Church, VA, USA.
⁵ Neuroscience Intensive Care Unit, Department of Medicine, INOVA Fairfax Medical Campus, Falls Church, VA, USA.
⁶ Neuroscience Research, Neuroscience and Spine Institute, INOVA Fairfax Medical Campus, Falls Church, VA, USA.
⁷ Zeenat Qureshi Stroke Institute, Columbia, MO, USA.

PMID: 33049464
PMCID: PMC7518171
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105344

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.

Keywords: Acute Ischemic Stroke; COVID-19; Hospital Admission; IV thrombolysis; Mechanical Thrombectomy; Mortality; Pandemic.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia / diagnosis
Brain Ischemia / mortality
Brain Ischemia / therapy*
COVID-19*
Community Health Services / trends
Female
Hospital Mortality
Hospitalization / trends*
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care / trends*
Recovery of Function
Retrospective Studies
Stroke / diagnosis
Stroke / mortality
Stroke / therapy*
Tertiary Care Centers / trends
Thrombectomy / trends*
Thrombolytic Therapy / trends*
Time Factors
Time-to-Treatment / trends*
Treatment Outcome
Virginia