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Abzhandadze T, Hoang MT, Mo M, Mostafaei S, Jurado PG, Xu H, Johnell K, Von Euler M, Eriksdotter M, Garcia-Ptacek S. COVID-19 Pandemic and Stroke Care in Patients with Dementia Compared to Other Stroke Patients. J Am Med Dir Assoc 2024; 25:105011. [PMID: 38702044 DOI: 10.1016/j.jamda.2024.03.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The primary objective of this study was to examine the impact of the COVID-19 pandemic on the quality of stroke care for patients with preexisting dementia, compared with patients who had only stroke. The secondary aim was to investigate how the quality of stroke care changed during the pandemic and post-pandemic periods compared with the pre-pandemic period in patients with preexisting dementia. DESIGN A registry-based, nationwide cohort study in Sweden. SETTING AND PARTICIPANTS We included patients with a first stroke between 2019 and 2022, both with and without dementia. The study periods were defined as follows: pre-pandemic (January 1, 2019, to February 29, 2020), COVID-19 pandemic (March 1, 2020, to February 24, 2022), and post-COVID-19 pandemic period (February 25, 2022, to September 19, 2022). The outcomes examined were the following quality indicators of stroke care, suggested by the national guideline of stroke care in Sweden: stroke admission site, performance of swallowing assessment, reperfusion treatment, assessment for rehabilitation, and early supported discharge. METHODS The associations were studied through group comparisons and binary logistic regressions. RESULTS Of the 21,795 patients with strokes, 1357 had documented preexisting dementia, and 20,438 had stroke without a dementia diagnosis. Throughout all study periods, a significantly lower proportion of patients with stroke with preexisting dementia, compared with stroke-only patients, received reperfusion treatment, assessments for rehabilitation, and early supported discharge from stroke units. In the subgroup of stroke patients with preexisting dementia, no significant associations were found regarding the quality indicators of stroke care before, during, and after the pandemic. CONCLUSIONS AND IMPLICATIONS Disparities in quality of stroke care were observed between stroke patients with preexisting dementia and those with only stroke during the COVID-19 pandemic. However, there were no statistically significant differences in stroke care for patients with dementia across the pandemic.
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Affiliation(s)
- Tamar Abzhandadze
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Minjia Mo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mia Von Euler
- Faculty of Medicine and Health, Department of Neurology and Rehabilitation, Örebro University, Örebro, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
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Gunnarsson K, Tofiq A, Mathew A, Cao Y, von Euler M, Ström JO. Changes in stroke and TIA admissions during the COVID-19 pandemic: A meta-analysis. Eur Stroke J 2024; 9:78-87. [PMID: 37776062 PMCID: PMC10916820 DOI: 10.1177/23969873231204127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To perform a meta-analysis on how the admissions of stroke and transient ischemic attack (TIA) changed during the Corona Virus infection-19 (COVID-19) pandemic and evaluate if the effect was depending on stroke severity. METHODS Observational cohort studies comparing the number of stroke and/or TIA admissions during a period of the pandemic compared to a period before the pandemic were identified in PubMed and Embase. After excluding studies with overlapping populations and studies without satisfactory case ascertainment, data was extracted and meta-analyzed. FINDINGS A total of 59 studies were included. During the pandemic, there was a decrease in admissions of ischemic stroke (admission rate ratio (ARR) = 0.77, 95% confidence interval (CI): 0.72, 0.82), intracerebral hemorrhage (ARR = 0.79, 95% CI: 0.70, 0.90) and TIA (ARR = 0.66, 95% CI: 0.58, 0.75). Albeit admission rates of both mild (ARR = 0.61, 95% CI: 0.49, 0.77) and severe (ARR = 0.82, 95% CI = 0.71, 0.95) strokes decreased, milder strokes decreased more (proportion ratio (PR) = 0.76, 95% CI: 0.65, 0.89). DISCUSSION Potential causes for the admission reduction could be strict prioritizations within the health care, patients' fear of acquiring COVID-19, or decreased access to health care due to lockdowns. CONCLUSION During the COVID-19 pandemic, there was a reduction in admissions of stroke and TIA, possibly caused by reluctance to seek medical care.
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Affiliation(s)
- Karin Gunnarsson
- Department of Neurology and rehabilitation, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Avin Tofiq
- Department of Neurology and rehabilitation, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Alen Mathew
- Department of Neurology and rehabilitation, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mia von Euler
- Department of Neurology and rehabilitation, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jakob O Ström
- Department of Neurology and rehabilitation, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Kongbunkiat K, Jumparway D, Vorasoot N, Kasemsap N, Sawanyawisuth K, Tiamkao S. Impact of COVID-19 outbreak on stroke admission in Thailand: a quasi-experimental, ecological study on national database. Infect Ecol Epidemiol 2023; 13:2270261. [PMID: 37881349 PMCID: PMC10595383 DOI: 10.1080/20008686.2023.2270261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/09/2023] [Indexed: 10/27/2023] Open
Abstract
This study aimed to evaluate the effect of COVID-19 outbreak on stroke admission by using a national database. A quasi-experimental, ecological study using the national database of Thailand was conducted. The study period was between January 2017 and August 2020 before and after COVID-19 outbreak starting from March 2020. Numbers of stroke admission were evaluated before and after the COVID-19 outbreak by an interrupted time series analysis for both pre- and post-COIVD-19 outbreak. There were 381,891 patients admitted throughout Thailand. Of those, 292,382 patients (76.56%) were admitted due to thrombotic stroke followed by hemorrhagic stroke (73,130 patients; 19.15%) and embolic stroke (16,379 patients; 4.29%). During pre-COVID-19 outbreak, all stroke subtypes had an increasing trend with a coefficient of 0.076 (p value < 0.001) for thrombotic stroke, 0.003 (p value < 0.001) for embolic stroke and 0.012 (p value = 0.025) for hemorrhagic stroke. The COVID-19 outbreak had significantly effect on reductions of incidence rates of thrombotic and hemorrhagic stroke with a coefficient of -2.412 (p value < 0.001) and -0.803 (p value = 0.023). The incidence rates of three stroke subtypes were increasing prior to the COVID-19 outbreak. The COVID-19 outbreak significantly impacts hospital admission rates of both thrombotic and hemorrhagic stroke subtypes.
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Affiliation(s)
- Kannikar Kongbunkiat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Donlagon Jumparway
- ASEAN Cancer Epidemiology and Prevention Research Group, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Nisa Vorasoot
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Narongrit Kasemsap
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Brown GG, Foroughi R, Bandela S, Cardentey A, Clark KL, Dula AN. A tale of two cities: A retrospective observational cohort study of the impact of COVID-19 on acute stroke presentation, timing, and outcomes. J Stroke Cerebrovasc Dis 2023; 32:107274. [PMID: 37506542 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES The purpose of this study was to identify the impact of COVID-19-related "shelter in place" restrictions on stroke metrics in two metropolitan Texas cities, Austin and San Antonio. MATERIALS AND METHODS Data was derived from stroke quality metric registries and compared between two treatment periods: (1) during the state's COVID-19 "shelter in place" restriction period, and (2) the corresponding period during the previous year for Austin and San Antonio, Texas. Primary outcomes include the dichotomized process measures of time last known well (TLKW) to arrival, arrival to brain imaging initiation, and arrival to administration of thrombolytic therapy. Secondary outcomes are clinical endpoints: independent ambulation at discharge, discharge to home, and in-hospital mortality. RESULTS Austin patients were older and presented with less-severe strokes. San Antonio patients were more likely to be Hispanic, suffer from a large vessel occlusion, and have independent ambulation at discharge (adjusted odds ratio, 2.04; 95% confidence intervals, (1.25-3.37). Within-city analyses revealed a trend toward increased TLKW to arrival in Austin and San Antonio during COVID-19. During COVID, Austin patients had decreased length of stay (LOS) while a higher proportion of San Antonio patients had a favorable outcome (discharged home & independent ambulation). CONCLUSIONS Longer TLKW to hospital arrival during COVID did not impact arrival-to-imaging, arrival-to-treatment times nor patient outcomes, even in patients at higher risk for stroke. Future studies should continue to assess the impact of COVID-19 on stroke care and outcomes pre- and post-introduction of the COVID-19 vaccine, and as infectivity rates spike or recede.
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Affiliation(s)
| | - Razieh Foroughi
- Departments of Neurology and Diagnostic Medicine, Dell Medical School at University of Texas at Austin, USA; Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sujani Bandela
- Departments of Neurology and Neurosurgery, The University of Texas Health Science Center at San Antonio, USA
| | - Agnelio Cardentey
- Departments of Neurology and Neurosurgery, The University of Texas Health Science Center at San Antonio, USA
| | - Kal L Clark
- Department of Radiology, The University of Texas Health Science Center at San Antonio, USA
| | - Adrienne N Dula
- Departments of Neurology and Diagnostic Medicine, Dell Medical School at University of Texas at Austin, USA.
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Takács TT, Berki ÁJ, Böjti PP, Stang R, Fritz-Reunes PA, Schnekenberg L, Siepmann T, Pintér A, Szatmári S, Bereczki D, Gunda B. The impact of SARS-CoV-2 infection on the outcome of acute ischemic stroke-A retrospective cohort study. PLoS One 2023; 18:e0282045. [PMID: 36862706 PMCID: PMC9980769 DOI: 10.1371/journal.pone.0282045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection (COVID-19), but the prognosis of these patients is poorly understood. PURPOSE To explore the impact of COVID-19 on neurological outcomes in AIS patients. METHODS A comparative retrospective cohort study was conducted in 32 consecutive AIS patients with and 51 without COVID-19 between the 1st of March 2020 and 1st of May 2021. The evaluation was based on a detailed chart review for demographic data, medical history, stroke severity, cranial and vessel imaging results, laboratory parameters, COVID-19 severity, hospitalization time, in-hospital mortality, and functional deficits at discharge (modified Rankin Scale, mRS). RESULTS COVID-19 AIS patients showed tendency to worse initial neurological deficit (NIHSS 9 (3-13) vs. 4 (2-10); p = 0.06), higher rate of large vessel occlusion (LVO; 13/32 vs. 14/51; p = 0.21), had prolonged hospitalization (19.4 ± 17.7 vs. 9.7 ± 7 days; p = 0.003), had lower chance of functional independence (mRS≤2) (12/32 vs. 32/51; p = 0.02) and showed higher in-hospital mortality (10/32 vs. 6/51; p = 0.02). In COVID-19 AIS patients, LVO was more common with COVID-19 pneumonia than without (55.6% vs. 23.1%; p = 0.139). CONCLUSION COVID-19-related AIS carries a worse prognosis. COVID-19 with pneumonia seems to be associated with a higher rate of LVO.
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Affiliation(s)
- Tímea Tünde Takács
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
- * E-mail:
| | - Ádám József Berki
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
| | - Péter Pál Böjti
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Rita Stang
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
| | | | - Luiz Schnekenberg
- University Hospital Carl Gustav Carus, Department of Neurology, Dresden, Germany
| | - Timo Siepmann
- University Hospital Carl Gustav Carus, Department of Neurology, Dresden, Germany
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Alexandra Pintér
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Semmelweis University, Department of Family Medicine, Budapest, Hungary
| | - Szabolcs Szatmári
- Semmelweis University, Department of Neurology, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group ELKH, Budapest, Hungary
| | - Dániel Bereczki
- Semmelweis University, Department of Neurology, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group ELKH, Budapest, Hungary
- European Academy of Neurology, EANcore COVID-19 Task Force, Vienna, Austria
| | - Bence Gunda
- Semmelweis University, Department of Neurology, Budapest, Hungary
- Semmelweis University, “János Szentágothai” Doctoral School of Neurosciences, Budapest, Hungary
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Katsouras CS, Papafaklis MI, Giannopoulos S, Karapanayiotides T, Tsivgoulis G, Michalis LK. Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction? J Clin Neurol 2023; 19:1-11. [PMID: 36606641 PMCID: PMC9833878 DOI: 10.3988/jcn.2023.19.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/04/2023] Open
Abstract
Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.
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Affiliation(s)
- Christos S Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Faculty of Health Sciences, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
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Brunssen A, Rücker V, Heuschmann P, Held J, Hermanek P, Berlis A, Hecht M, Berger K. Stroke care during the COVID-19 pandemic: Case numbers, treatments, and mortality in two large German stroke registries. Front Neurol 2022; 13:924271. [PMID: 35968290 PMCID: PMC9367687 DOI: 10.3389/fneur.2022.924271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background and purpose At 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 methods The 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). 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. Results Hospitalization 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. Conclusion Case 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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Affiliation(s)
- Alicia Brunssen
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
- *Correspondence: Alicia Brunssen
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center (P.U.H.), Würzburg University Hospital, Würzburg, Germany
| | - Jana Held
- Bavarian Working Party for Quality Assurance, Munich, Germany
| | - Peter Hermanek
- Bavarian Working Party for Quality Assurance, Munich, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Martin Hecht
- Department of Neurology, Bezirkskliniken Schwaben, Kaufbeuren, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Ramachandran D, Panicker P, Chithra P, Iype T. Time Metrics in Acute Ischemic Stroke Care During the Second and First Wave of COVID 19 Pandemic: A Tertiary Care Center Experience from South India. J Stroke Cerebrovasc Dis 2022; 31:106315. [PMID: 35298996 PMCID: PMC8758333 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background During the first wave of the pandemic, stroke care suffered globally and there were reduced stroke admissions and delays in time metrics. Stroke care was reorganized during the second wave learning from the experience of previous wave. This study shares our experience in stroke time metrics during the second wave of pandemic compared to the first wave. Methods We did a single-center prospective study, where consecutive acute ischemic stroke patients within 24 hours of the onset of symptoms and aged more than 18 years, who presented to Stroke Unit, Department of Neurology, Government Medical College, Thiruvananthapuram from June 1st to 31st August, 2020 and June 1st to 31st August in 2021 were included. In-hospital time metrics (door to CT time and door to Needle time) were compared during the two time periods. We also compared functional outcomes at discharge and in-hospital mortality during the two periods. Functional outcome at discharge was assessed by modified Rankin scale (mRS). Results From June to August 2021 (second wave of the COVID 19 pandemic), compared to the same months during the first wave (2020), our study demonstrated better in-hospital time metrics (door to CT time and door to needle time). We also found lower admission systolic blood pressure and higher baseline CT early ischemic changes during the second wave. There was no difference in functional outcome at discharge and in-hospital mortality. Intravenous thrombolysis rates also remained the same during the two periods. Conclusion Our study has confirmed that time metrics in stroke care can be improved through system rearrangement even during the pandemic. Acute stroke treatments are time-dependent and hospital administrators must stick to the maxim “Time is Brain” while restructuring stroke workflows during future challenges.
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Ackah M, Salifu MG, Ameyaw L, Boakye H, Yeboah CO. Impact of COVID-19 pandemic on acute stroke admissions and case-fatality rate in lower-income and middle-income countries: a protocol for systematic review and meta-analysis. BMJ Open 2022; 12:e057893. [PMID: 35470196 PMCID: PMC9039155 DOI: 10.1136/bmjopen-2021-057893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/07/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The current review primarily aims to ascertain the impact of COVID-19 on stroke admission as well as stroke case fatality in Low-income and Middle-Income Countries (LMICs). METHODS AND ANALYSIS Four international databases (PubMed/Medline, Google Scholar, African Journals Online, Latin American and Caribbean Health Sciences Literature) and one preprint database (medRxiv). Studies will be included if they are conducted in LMICs, all stroke types without age and language restriction, from December 2019 to 31 December 2021. Two authors will screen the titles and abstracts against the prespecified eligibility criteria for inclusion in the review, and then repeat the process after retrieving the full text. Joanna Briggs critical appraisal checklist for analytical cross-sectional studies will be used for the quality assessment and risk of bias by two coauthors. The characteristics of the studies will be presented and summarised in a table. We aim to perform meta-analyses on a pooled proportional change in acute stroke admissions and case fatality with 95% CI using a random-effects meta-analysis. Publication bias will be assessed using funnel plot and Egger's regression test if ≥10 studies are involved. A sub group analysis will be performed to determine the sources of heterogeneity. Leave-one-out sensitivity analysis will be performed to examine the impact of a single study on the overall pool estimate. ETHICS AND DISSEMINATION Ethical approval is not required as this is secondary research and will use reported data in scientific literature. A full manuscript will be submitted to a reputable peer-review journal for publication and disseminated electronically and in print. PROSPERO REGISTRATION NUMBER CRD42021281580.
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Affiliation(s)
- Martin Ackah
- Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Ghana
- School of Public Health, Department of Epidemiology and Disease Control, University of Ghana, Legon, Greater Accra, Ghana
| | - Mohammed Gazali Salifu
- School of Public Health, Department of Epidemiology and Disease Control, University of Ghana, Legon, Greater Accra, Ghana
- Monitoring and Evaluation Directorate, Ministry of Health, Accra, Ghana
| | - Louise Ameyaw
- School of Public Health, Department of Epidemiology and Disease Control, University of Ghana, Legon, Greater Accra, Ghana
| | - Hosea Boakye
- School of Public Health, Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
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Haki C, Deniz O. The impact of home quarantine during COVID-19 lockdown on neurological hospitalizations, in-hospital mortality, and acute ischemic stroke management in older patients without COVID-19. Clin Neurol Neurosurg 2022; 212:107027. [PMID: 34839154 PMCID: PMC8604567 DOI: 10.1016/j.clineuro.2021.107027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study aimed to investigate the impact of home quarantine in older patients without COVID-19 hospitalized due to neurological disorders. METHODS We consecutively enrolled 255 elderly patients(median age: 75 years, female: 54%), including 180 (70%) in the pre-home quarantine period and 75 (30%) home quarantine period from January to May 2020 (ten weeks before and ten weeks after the March 21, 2020, lockdown for older patients in Turkey) in a tertiary referral neurological center. RESULTS In the home quarantine period, we documented a fall in the number of neurological admissions by 58.3%, but an increased need for intensive care in older patients. Patients in the home quarantine period were younger [73 (65-91) vs 76 (65-95), p = 0.005], had worse Glasgow Coma Scores (12.3 ± 3.6 vs 13.7 ± 2.5, p = 0.007), higher in-hospital mortality rate (21.3% vs. 6.7%, p = 0.001), had a lower prevalence of comorbidities such as diabetes mellitus, hypertension, and cardiovascular disease, and chronic neurologic disease, albeit had a higher prevalence of the acute cerebrovascular disease (hemorrhagic/ ischemic stroke)(90.7% vs 78.9, p = 0.025). In this period, even there was an increase in the proportion of the patients undergoing reperfusion therapy, it wasn't statistically significant (20.3% vs. 10.1%, p: 0.054). Multivariate analysis revealed that high NIHSS (The National Institutes of Health Stroke Scale) score (OR=1.25; p < 0.001) and hospitalization in the home quarantine period (OR=3.21; p = 0.043) were independently associated with in-hospital mortality. CONCLUSION Our study indicated that during the COVID-19 home quarantine period, despite a significantly fewer number of patients admitted to the hospitalization, there was a higher percentage of those hospitalized needing intensive care and an overall worse prognosis.
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Affiliation(s)
- Cemile Haki
- Neurology Clinic, Bursa City Hospital, Bursa, Turkey
| | - Olgun Deniz
- Geriatric Medicine Clinic, Palliative Care Unit, Bursa City Hospital, Bursa, Turkey.
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Zafra-Tanaka JH, Portocarrero J, Abanto C, Zunt JR, Miranda JJ. Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru. J Stroke Cerebrovasc Dis 2021; 31:106275. [PMID: 35121533 PMCID: PMC8702405 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. METHODS A qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients' journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. RESULTS We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. CONCLUSION The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients' experiences and feelings by developing solutions in a participatory manner.
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Affiliation(s)
- Jessica Hanae Zafra-Tanaka
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru.
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Joseph R Zunt
- Departments of Neurology and Global Health, University of Washington, Seattle, United States
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, Australia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bahadori M, Mowla A. Re: Tenecteplase for thrombolysis in stroke patients: Systematic review with meta-analysis. Am J Emerg Med 2021; 55:185-186. [PMID: 34116894 PMCID: PMC9010854 DOI: 10.1016/j.ajem.2021.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Maryam Bahadori
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America
| | - Ashkan Mowla
- Division of Stroke Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America.
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