COVID-19 pandemic results in decreased global stroke care

The numbers of global stroke hospitalisations, intravenous thrombolysis (IVT), and IVT interfacility transfers have declined during the COVID-19 pandemic. A cross-sectional, observational, retrospective study investigated the effect of the pandemic on global stroke care.

Primary research objective of this study, presented by Dr Thanh Ngoc Nguyen (Boston University School of Medicine, Massachusetts, USA), was to determine whether stroke care showed an overall decline on the global level [1]. Data was collected from 457 stroke centres in 70 countries, covering 6 continents. Dr Nguyen mentioned that under-resourced countries, low-income regions, and primary stroke centres were the main targets. Secondary objectives were to examine the intersection of COVID-19 and stroke diagnoses and compare the early to the later pandemic months.

ICD-10 codes and classifications in stroke centre databases were used to identify the predetermined patient characteristics (stroke hospitalisation, IVT, IVT transfer, COVID-19 hospitalisation). The study compared the 4 months of the first pandemic peak (1 March to 30 June 2020) to two 4-month control periods prior to the pandemic onset (1 March to 30 June 2019; 1 November to 29 February 2020).

Results showed that there were 11.5% fewer stroke admissions during the pandemic months (n=80,894) in comparison with the 4 preceding months (n=91,373). Continents differed in their decline rates of stroke hospitalisations. Africa (30.2%) and North America (18.8%) showed large reduction rates, whereas Asia (6.5%) and Oceania (1.9%) were more resilient to these declines. The amount of COVID-19 hospitalisations per site correlated with steeper decline rates in stroke admissions. Low versus high numbers of COVID-19 admissions showed a 3.2% versus 17.5% reduction in stroke hospitalisations respectively. IVT (13.2%) and IVT transfers (11.9%) demonstrated similar decrease rates during the pandemic peak months. Stroke was present in 1.48% of the COVID-19 admissions and COVID-19 was diagnosed in 3.3% of the stroke admissions. Recovery in stroke care (9.5%) was seen in the later pandemic months. This improvement did not apply to IVT.

Dr Nguyen interpreted the global decline in stroke care during the first pandemic wave as being irrespective of COVID-19 hospital burden or pre-pandemic stroke and IVT volumes. Primary stroke centres with more COVID-19 admissions showed steeper decline rates and recovery was seen during the later months of the pandemic.

1. Nguyen TN, et al. Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis. N3.002, AAN 2021 Virtual Congress, 17-22 April.

Posted on 22 April, 202117 June, 2021