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Chen Y, Lei Q, Li J, Li J, He Y, Li J, Xing S, Fan Y, Zeng J. Certification of stroke centers at primary hospitals and the improvement of thrombolysis n South China during 2020-2022. Eur Stroke J 2024; 9:477-485. [PMID: 38189301 PMCID: PMC11318416 DOI: 10.1177/23969873231223062] [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: 10/15/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION IVT use declined globally in 2020 due to the Corona Virus Disease 2019 (COVID-19) pandemic, but it increased in South China. This study was conducted to evaluate the association of establishing Stroke Prevention Centers (SPCs) at primary hospitals with IVT increase in South China. MATERIALS AND METHODS We conducted a longitudinal observational study across 336 hospitals in 114 areas in South China during 2020-2022. Data regarding certified stroke centers, IVT volumes, and IVT rates were collected. Correlations between IVT rates and the number or density of stroke centers were accessed. IVT use was compared among areas with different levels of stroke centers or on different certification process. RESULTS During 2020-2022, there were 83, 125, and 152 stroke centers, with 26, 65, and 92 SPCs, respectively. IVT therapies were 12,795, 17,266, and 20,411, representing a 29.8% increase/year (all p < 0.001). IVT rates increased from 7.2% in 2020 to 8.8% and 10.4% in 2021 and 2022, demonstrating a 22.2% increase/year (all p < 0.001). IVT rates correlated with the number and density of SPCs (all p < 0.05). IVT rates were higher in areas equipped with SPCs than in those without stroke centers (all p < 0.05). IVT rates consistently increased during the SPC certification process from 1 year before through the certification and subsequent maintenance (both p < 0.05). DISCUSSION AND CONCLUSION Well-organised SPCs and IVT therapy demonstrated substantial increase during the 3-year period. Certification of SPCs at primary hospitals is associated with improved IVT therapy in South China even with city lockdown during COVID-19 pandemic.
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Affiliation(s)
- Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Qingfeng Lei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
- Department of Neurology, The Sixth Affiliated Hospital, Sun Yat-sen University, Yuancun, Guangzhou, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jianle Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yinxin He
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jingjing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Shihui Xing
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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2
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Khan Y, Verhaeghe N, Devleesschauwer B, Cavillot L, Gadeyne S, Pauwels N, Van den Borre L, De Smedt D. The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:647-661. [PMID: 37667483 DOI: 10.1093/ehjqcco/qcad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
AIMS Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. METHODS AND RESULTS PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. CONCLUSION The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.
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Affiliation(s)
- Yasmine Khan
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Research Institute for Work and Society, KU Leuven, Leuven 3000, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent 9000, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke 9000, Belgium
| | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Research Institute of Health and Society, University of Louvain, Brussels 1200, Belgium
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nele Pauwels
- Faculty of Medicine, Ghent University, Ghent 9000, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
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Rivera R, Amudio C, Cruz JP, Brunetti E, Catalan P, Sordo JG, Echeverria D, Badilla L, Chamorro A, Gonzalez C, Ojeda H, Rodriguez C, Rogers N, Bravo L, Bravo F, Carrasco A, Gonzalez W, Lopez S, Orellana ML, Oportus M, Salazar A, Palacios G, Nguyen PT. The impact of a two-year long COVID-19 public health restriction program on mechanical thrombectomy outcomes in a stroke network. J Stroke Cerebrovasc Dis 2023; 32:107138. [PMID: 37087772 PMCID: PMC10106818 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of COVID-19 pandemic public health restrictions on our drip and ship mechanical thrombectomy program in Santiago Chile. MATERIALS AND METHODS This was a retrospective analysis of a prospectively collected database comparing two cohorts, one during a two-year period before COVID-19 and the second during the two years of the pandemic at our metropolitan stroke program. RESULTS A total of 100 patients were included in the pre COVID-19 cohort (cohort 1) and 121 in the COVID-19 cohort (cohort 2). There was a significant difference between cohorts, with older patients, different occlusion sites and higher door to arterial puncture time during the COVID-19 period. A non-significant trend for worse 90-day outcomes and higher mortality was present in cohort 2. There were no statistical differences in safety treatment parameters. CONCLUSIONS COVID-19 pandemic has had a measurable impact on our mechanical thrombectomy program. Results showed similarities to other reported Latin American series, where less robust health systems could adapt less efficiently compared to developed countries. After two years of public health restrictions, there were changes in the treatment population characteristics, delay in some internal management metrics and a non-significant trend to worse 90-day outcomes and higher mortality.
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Affiliation(s)
- Rodrigo Rivera
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile.
| | - Cristian Amudio
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Juan Pablo Cruz
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Enzo Brunetti
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Pascual Catalan
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Juan Gabriel Sordo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Daniel Echeverria
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Lautaro Badilla
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Alex Chamorro
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Christian Gonzalez
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Héctor Ojeda
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Cristian Rodriguez
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Nicole Rogers
- Critical Care Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Loreto Bravo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Fabian Bravo
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Alejandra Carrasco
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Walter Gonzalez
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Sofia Lopez
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Maria Luisa Orellana
- Neuroradiology Department, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Monica Oportus
- Anesthesia Unit, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Alejandro Salazar
- Anesthesia Unit, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Gerardo Palacios
- Anesthesia Unit, Instituto de Neurocirugia Dr. Alfonso Asenjo, Santiago - Chile
| | - Prof Thanh Nguyen
- Interventional neurology/ neuroradiology at Boston Medical Center (BMC), Boston MA - USA
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Shinoda J, Ichimura S, Kanai R, Majima T, Azami S, Inoue K, Shirai T. Impact of JSS-PCS on the In-Hospital Workflow and Outcomes of Reperfusion Therapy for Acute Ischemic Stroke: Cases of a Metropolitan Secondary Emergency Facility. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 17:37-46. [PMID: 37502129 PMCID: PMC10370527 DOI: 10.5797/jnet.oa.2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/28/2022] [Indexed: 07/29/2023]
Abstract
Objective Protected code stroke has been widely introduced in the emergency medical system for acute stroke in the current coronavirus disease 2019 (COVID-19) pandemic. This study aims to confirm the effects of protected code stroke formulated by the Japan Stroke Society (JSS-PCS) on the quality and outcomes of reperfusion therapy for acute ischemic stroke (AIS), followed by evaluating its validity. Methods The subjects were 109 consecutive patients with AIS who underwent reperfusion therapy between January 2016 and July 2021, excluding in-hospital onset cases. Patients were classified according to the treatment date into the pre-COVID-19 (n = 82) and the with-COVID-19 (n = 27) groups. JSS-PCS was applied to all patients in the latter group. Statistical comparisons were made between groups on time indicators for initial treatment (onset-to-door time, door-to-imaging time [DTI], door-to-needle time [DTN], door-to-puncture time [DTP], door-to-reperfusion time, and puncture-to-reperfusion time [PTR]). The time indicator transition over the entire period was also evaluated by subgroup analysis. Subsequently, the outcomes at discharge were statistically compared between the two periods, followed by a subgroup comparison. Finally, univariate and multivariate analyses examined whether the application of JSS-PCS affected clinical outcomes. Results Slight delays were revealed in DTI, DTN, DTP, and PTR in the with-COVID-19 group with no statistical significance. The time indicators were delayed once entering the period of the COVID-19 pandemic and then shortened again. The outcomes at discharge tended to worsen slightly in the with-COVID-19 group with no significance. Subgroup analysis depicted a transient deterioration of outcomes early in the pandemic. Applying JSS-PCS did not significantly affect clinical outcomes in univariate and multivariate analyses. Conclusion Regarding reperfusion therapy at our facility, the introduction and application of JSS-PCS during the COVID-19 pandemic significantly affected neither time indicators nor outcomes. Infection control should be a top priority in the first medical practice for AIS in today's world, where COVID-19 shows no signs of termination.
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Affiliation(s)
- Jun Shinoda
- Department of Stroke, Eiju General Hospital, Tokyo, Japan
- Department of Neurosurgery, Eiju General Hospital, Tokyo, Japan
| | - Saeko Ichimura
- Department of Neurosurgery, Eiju General Hospital, Tokyo, Japan
| | - Ryuichi Kanai
- Department of Neurosurgery, Eiju General Hospital, Tokyo, Japan
| | - Takamasa Majima
- Department of Stroke, Eiju General Hospital, Tokyo, Japan
- Department of Neurology, Eiju General Hospital, Tokyo, Japan
| | - Shumpei Azami
- Department of Stroke, Eiju General Hospital, Tokyo, Japan
- Department of Neurology, Eiju General Hospital, Tokyo, Japan
| | - Kouji Inoue
- Department of Neurology, Eiju General Hospital, Tokyo, Japan
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Siegler JE, Abdalkader M, Michel P, Nguyen TN. Therapeutic Trends of Cerebrovascular Disease during the COVID-19 Pandemic and Future Perspectives. J Stroke 2022; 24:179-188. [PMID: 35677974 PMCID: PMC9194541 DOI: 10.5853/jos.2022.00843] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/27/2022] [Indexed: 11/27/2022] Open
Abstract
As of May 2022, there have been more than 400 million cases (including re-infections) of the systemic acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), and nearly 5 million deaths worldwide. Not only has the coronavirus disease 2019 (COVID-19) pandemic been responsible for diagnosis and treatment delays of a wide variety of conditions, and overwhelmed the allocation of healthcare resources, it has impacted the epidemiology and management of cerebrovascular disease. In this narrative review, we summarize the changing paradigms and latest data regarding the complex relationship between COVID-19 and cerebrovascular disease. Paradoxically, although SARS-CoV-2 has been associated with many thrombotic complications—including ischemic stroke—there have been global declines in ischemic stroke and other cerebrovascular diseases. These epidemiologic shifts may be attributed to patient avoidance of healthcare institutions due to fear of contracting the novel human coronavirus, and also related to declines in other transmissible infectious illnesses which may trigger ischemic stroke. Despite the association between SARS-CoV-2 and thrombotic events, there are inconsistent data regarding targeted antithrombotics to prevent venous and arterial events. In addition, we provide recommendations for the conduct of stroke research and clinical trial planning during the ongoing COVID-19 pandemic, and for future healthcare crises.
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Affiliation(s)
- James E. Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Correspondence: James E. Siegler Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, USA Tel: +1-501-912-4392 Fax: +1-856-964-0504 E-mail:
| | - Mohamad Abdalkader
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Patrik Michel
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thanh N. Nguyen
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Nawabi NLA, Duey AH, Kilgallon JL, Jessurun C, Doucette J, Mekary RA, Aziz-Sultan MA. Effects of the COVID-19 pandemic on stroke response times: a systematic review and meta-analysis. J Neurointerv Surg 2022; 14:642-649. [PMID: 35387860 DOI: 10.1136/neurintsurg-2021-018230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES COVID-19 presents a risk for delays to stroke treatment. We examined how COVID-19 affected stroke response times. METHODS A literature search was conducted to identify articles covering stroke during COVID-19 that included time metrics data pre- and post-pandemic. For each outcome, pooled relative change from baseline and 95% CI were calculated using random-effects models. Heterogeneity was explored through subgroup analyses comparing comprehensive stroke centers (CSCs) to non-CSCs. RESULTS 38 included studies reported on 6109 patients during COVID-19 and 14 637 patients during the pre-COVID period. Pooled increases of 20.9% (95% CI 5.8% to 36.1%) in last-known-well (LKW) to arrival times, 1.2% (-2.9% to 5.3%) in door-to-imaging (DTI), 0.8% (-2.9% to 4.5%) in door-to-needle (DTN), 2.8% (-5.0% to 10.6%) in door-to-groin (DTG), and 19.7% (11.1% to 28.2%) in door-to-reperfusion (DTR) times were observed during COVID-19. At CSCs, LKW increased by 24.0% (-0.3% to 48.2%), DTI increased by 1.6% (-3.0% to 6.1%), DTN increased by 3.6% (1.2% to 6.0%), DTG increased by 4.6% (-5.9% to 15.1%), and DTR increased by 21.2% (12.3% to 30.1%). At non-CSCs, LKW increased by 12.4% (-1.0% to 25.7%), DTI increased by 0.2% (-2.0% to 2.4%), DTN decreased by -4.6% (-11.9% to 2.7%), DTG decreased by -0.6% (-8.3% to 7.1%), and DTR increased by 0.5% (-31.0% to 32.0%). The increases during COVID-19 in LKW (p=0.01) and DTR (p=0.00) were statistically significant, as was the difference in DTN delays between CSCs and non-CSCs (p=0.04). CONCLUSIONS Factors during COVID-19 resulted in significantly delayed LKW and DTR, and mild delays in DTI, DTN, and DTG. CSCs experience more pronounced delays than non-CSCs.
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Affiliation(s)
- Noah L A Nawabi
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA .,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akiro H Duey
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John L Kilgallon
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charissa Jessurun
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Joanne Doucette
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Library and Learning Resources, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pharmaceutical Business and Administrative Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Varrasi C, Fleetwood T, De Marchi F, Vecchio D, Virgilio E, Castello LM, Avanzi GC, Sainaghi PP, Mazzini L, Cantello R. Neurological emergency at the COVID-19 pandemic: report from a referral hospital in Eastern Piedmont, Italy. Neurol Sci 2022; 43:2195-2201. [PMID: 35039990 PMCID: PMC8763442 DOI: 10.1007/s10072-022-05895-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
Background The pandemic implied dramatic changes in public health assets. In Italy, some Stroke Units were transformed into sub-intensive COVID-19 Units, making the management of neurological patients demanding. We described how the flow of neurological emergencies was affected by the pandemic impact. Methods We analyzed accesses to the Emergency Department (ED) of the “Maggiore della Carità” Hospital, Piedmont, Italy, during a period of 8 months (COVID time; March to May 2020 and October 2020 to February 2021) and analyzed the admissions to the Neurology Unit and the underlying diagnosis. We also evaluated potential changes in the treatment of acute ischemic stroke in the same period. These variables were compared with two equivalent periods of time (2019–2020; 2018–2019). Results During the COVID time, there was a clear-cut reduction of the total ED accesses compared to NoCOVID times. However, admissions for acute neurological conditions showed a mild but non-significant decrease (6.3%vs.7.3%). The same applied to acute ischemic stroke, which represented the most common condition (47.7%). The proportion of patients who underwent emergent reperfusion therapies remained unchanged. Furthermore, no difference was found in door-to-needle and door-to-groin intervals between COVID time and NoCOVID times. On the contrary, the onset-to-door interval was significantly longer during the COVID time (p value: 0.001). Discussion While the percentage of admissions following an ED access grew dramatically, those to the Neurology Unit showed overall only a slight non-significant decrease. This finding implicitly reflects the serious and urgent nature of many neurological diseases, compelling people to access EDs at any time.
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Affiliation(s)
- Claudia Varrasi
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Thomas Fleetwood
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Fabiola De Marchi
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy.
| | - Domizia Vecchio
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Virgilio
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Luigi Mario Castello
- Emergency Department, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Novara, Italy
- Internal Medicine, A.O. Santi Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Gian Carlo Avanzi
- Emergency Department, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Novara, Italy
| | - Pier Paolo Sainaghi
- Emergency Department, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Novara, Italy
| | - Letizia Mazzini
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - Roberto Cantello
- Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
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Benali F, Stolze LJ, Rozeman AD, Dinkelaar W, Coutinho JM, Emmer BJ, Gons RAR, Yo LFS, van Tuijl JH, Boukrab I, van Dam-Nolen DHK, van den Wijngaard IR, Lycklama À Nijeholt GJ, de Laat KF, van Dijk LC, den Hertog HM, Flach HZ, Wermer MJH, van Walderveen MAA, Brouwers PJAM, Bulut T, Vermeer SE, Bernsen MLE, Uyttenboogaart M, Bokkers RPH, Boogaarts JD, de Leeuw FE, van der Worp HB, van der Schaaf IC, Schonewille WJ, Vos JA, Remmers MJM, Imani F, Dippel DWJ, van Zwam WH, Nederkoorn PJ, van Oostenbrugge RJ. Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands. BMC Neurol 2022; 22:22. [PMID: 35016635 PMCID: PMC8749107 DOI: 10.1186/s12883-021-02539-4] [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] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.
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Affiliation(s)
- Faysal Benali
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Lotte J Stolze
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anouk D Rozeman
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Wouter Dinkelaar
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart J Emmer
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rob A R Gons
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Lonneke F S Yo
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Julia H van Tuijl
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Issam Boukrab
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Dianne H K van Dam-Nolen
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | | | - Karlijn F de Laat
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Lukas C van Dijk
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Heleen M den Hertog
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - H Zwenneke Flach
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Paul J A M Brouwers
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tomas Bulut
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Sarah E Vermeer
- Department of Neurology and Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Reinoud P H Bokkers
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen D Boogaarts
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Irene C van der Schaaf
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter J Schonewille
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan A Vos
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Michel J M Remmers
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Farshad Imani
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wim H van Zwam
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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9
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Katsanos AH, Palaiodimou L, Zand R, Yaghi S, Kamel H, Navi BB, Turc G, Benetou V, Sharma VK, Mavridis D, Shahjouei S, Catanese L, Shoamanesh A, Vadikolias K, Tsioufis K, Lagiou P, Sfikakis PP, Alexandrov AV, Tsiodras S, Tsivgoulis G. Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Stroke 2021; 52:3651-3660. [PMID: 34344166 PMCID: PMC8547579 DOI: 10.1161/strokeaha.121.034601] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. METHODS Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. RESULTS We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, -1.19 [95% CI, -2.05 to -0.32]; I2=70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01-1.22]; I2=54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12-0.98]; I2=90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07-2.48]; I2=49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05-1.52]; I2=55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05-1.47]; I2=40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. CONCLUSIONS The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.).,Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.)
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.)
| | - Ramin Zand
- Neurosience Institute, Geisinger Health System, Danville, Pennsylvania (R.Z., S.S.)
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, NY (S.Y.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (H.K., B.B.N.)
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (H.K., B.B.N.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, France (G. Turc).,Université de Paris, France (G. Turc).,INSERM U1266, Paris, France (G. Turc).,FHU Neurovasc, Paris, France (G. Turc)
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (V.B., P.L.)
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore and School of Medicine, National University of Singapore (V.K.S.)
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Greece (D.M.).,Université Paris Descartes, Faculté de Médecine, France (D.M.)
| | - Shima Shahjouei
- Neurosience Institute, Geisinger Health System, Danville, Pennsylvania (R.Z., S.S.)
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.)
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., L.C., A.S.)
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece (K.V.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (K.T.)
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece (V.B., P.L.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.)
| | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece (P.P.S.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G. Tsivgoulis)
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.T.).,National Public Health Organization of Greece, Athens (S.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.H.K., L.P., G. Tsivgoulis.).,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G. Tsivgoulis)
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10
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Aboul Nour H, Affan M, Mohamed G, Mohamud A, Schultz L, Latack K, Brady M, Scozzari D, Haddad Y, Katramados A, Bou Chebl A, Ramadan AR. Impact of the COVID-19 Pandemic on Acute Stroke Care, Time Metrics, Outcomes, and Racial Disparities in a Southeast Michigan Health System. J Stroke Cerebrovasc Dis 2021; 30:105746. [PMID: 33780695 PMCID: PMC7997457 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND COVID-19 has impacted acute stroke care with several reports showing worldwide drops in stroke caseload during the pandemic. We studied the impact of COVID-19 on acute stroke care in our health system serving Southeast Michigan as we rolled out a policy to limit admissions and transfers. METHODS in this retrospective study conducted at two stroke centers, we included consecutive patients presenting to the ED for whom a stroke alert was activated during the period extending from 3/20/20 to 5/20/20 and a similar period in 2019. We compared demographics, time metrics, and discharge outcomes between the two groups. RESULTS of 385 patients presented to the ED during the two time periods, 58% were African American. There was a significant decrease in the number of stroke patients presenting to the ED and admitted to the hospital between the two periods (p <0.001). In 2020, patients had higher presenting NIHSS (median: 2 vs 5, p = 0.012), discharge NIHSS (median: 2 vs 3, p = 0.004), and longer times from LKW to ED arrival (4.8 vs 9.4 h, p = 0.031) and stroke team activation (median: 10 vs 15 min, p = 0.006). In 2020, stroke mimics rates were lower among African Americans. There were fewer hospitalizations (p <0.001), and transfers from outside facilities (p = 0.015). CONCLUSION a trend toward faster stroke care in the ED was observed during the pandemic along with dramatically reduced numbers of ED visits, hospitalizations and stroke mimics. Delayed ED presentations and higher stroke severity characterized the African American population, highlighting deepening of racial disparities during the pandemic.
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Affiliation(s)
- Hassan Aboul Nour
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States.
| | - Muhammad Affan
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States; Department of Neurology, University of Minnesota, Minneapolis, MN, United States.
| | - Ghada Mohamed
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States.
| | - Ali Mohamud
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States.
| | - Lonni Schultz
- Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States.
| | - Katie Latack
- Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States.
| | - Megan Brady
- Comprehensive Stroke Center, Henry Ford Health System, Detroit, MI, United States.
| | - Dawn Scozzari
- Comprehensive Stroke Center, Henry Ford Health System, Detroit, MI, United States.
| | - Yazeed Haddad
- School of Medicine, Wayne State University, Detroit, MI, United States.
| | - Angelos Katramados
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States.
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States.
| | - Ahmad Riad Ramadan
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States.
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11
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Venketasubramanian N, Anderson C, Ay H, Aybek S, Brinjikji W, de Freitas GR, Del Brutto OH, Fassbender K, Fujimura M, Goldstein LB, Haberl RL, Hankey GJ, Heiss WD, Lestro Henriques I, Kase CS, Kim JS, Koga M, Kokubo Y, Kuroda S, Lee K, Lee TH, Liebeskind DS, Lip GYH, Meairs S, Medvedev R, Mehndiratta MM, Mohr JP, Nagayama M, Pantoni L, Papanagiotou P, Parrilla G, Pastori D, Pendlebury ST, Pettigrew LC, Renjen PN, Rundek T, Schminke U, Shinohara Y, Tang WK, Toyoda K, Wartenberg KE, Wasay M, Hennerici MG. Stroke Care during the COVID-19 Pandemic: International Expert Panel Review. Cerebrovasc Dis 2021; 50:245-261. [PMID: 33756459 PMCID: PMC8089455 DOI: 10.1159/000514155] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/16/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. SUMMARY The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.
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Affiliation(s)
| | - Craig Anderson
- The George Institute for Global Health, Camperdown, Washington, Australia
| | - Hakan Ay
- Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA
- Takeda Pharmaceutical Co. Limited, Cambridge, Massachusetts, USA
| | - Selma Aybek
- Department of Neurology, University Hospital Inselspital, Bern University, Bern, Switzerland
| | - Waleed Brinjikji
- Department of Radiology, Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabriel R de Freitas
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Department of Neurology, Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Oscar H Del Brutto
- School of Medicine, Universidad Espiritu Santo-Ecuador, Samborondón, Ecuador
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
- Division of Advanced Cerebrovascular Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Larry B Goldstein
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Roman L Haberl
- Department of Neurology and Neurological Intensive Medicine, Munich Clinic gGmbH, Academic Teaching Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Perth, Washington, Australia
| | | | - Isabel Lestro Henriques
- Department of Neurosciences, Neurology Service, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Carlos S Kase
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jong S Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kiwon Lee
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stephen Meairs
- Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Roman Medvedev
- Research Center of Neurology, Moscow, Russian Federation
| | | | - Jay P Mohr
- Tananbaum Stroke Center, New York, New York, USA
| | - Masao Nagayama
- Department of Neurology, International University of Health and Welfare(IUHW), Graduate School of Medicine, Tokyo, Japan
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany
- Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Guillermo Parrilla
- Department of Neurology, Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sarah T Pendlebury
- Departments of Internal Medicine and Geratology, John Radcliffe Hospital, Oxford, United Kingdom
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom
| | | | | | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ulf Schminke
- Department of Neurology, University Medicine, Greifswald, Germany
| | | | - Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Mohammad Wasay
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Michael G Hennerici
- Department of Neurology, Medical Faculty, Mannheim University of Heidelberg, Mannheim, Germany
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12
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Gabet A, Grave C, Tuppin P, Chatignoux E, Béjot Y, Olié V. 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. Eur J Neurol 2021; 28:3279-3288. [PMID: 33738913 PMCID: PMC8251122 DOI: 10.1111/ene.14831] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this nationwide study was to assess the impact of the COVID-19 pandemic on stroke hospitalization rates, patient characteristics and 30-day case fatality rates. METHODS All hospitalizations for stroke from January to June of each year from 2017 to 2020 were selected using International Classification of Diseases, 10th revision, codes I60 to I64 in the national hospital discharge database. Patient characteristics and management were described according to three time periods: pre-lockdown, lockdown, and post-lockdown. Weekly incidence rate ratios (IRRs) were computed to compare time trends in the rates of patients hospitalized for stroke as well as in-hospital and 30-day case fatality rates between the years 2017-2019 and 2020. RESULTS In 2020, between weeks 1 and 24, 55,308 patients were hospitalized for stroke in France. IRRs decreased by up to 30% for all age groups, sex, and stroke types during the lockdown compared to the period 2017-2019. Patients hospitalized during the second and third weeks of the lockdown had higher in-hospital case fatality rates compared to 2017-2019. In-hospital case fatality rates increased by almost 60% in patients aged under 65 years. Out-of-hospital 30-day case fatality rates increased between weeks 11 and 15 among patients who returned home after their hospitalization. Important changes in care management were found, including fewer stroke patients admitted to resuscitation units, more admitted to stroke care units, and a shorter mean length of hospitalization. CONCLUSIONS During the first weeks of the lockdown, rates of patients hospitalized for stroke fell by 30% and there were substantial increases of both in-hospital and out-of-hospital 30-day case fatality rates.
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13
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Schlachetzki F, Wilfling S, Hubert ND, Wagner A, Haberl RL, Linker RA, Hubert GJ. Decline and Recurrence of Stroke Consultations during the COVID-19 Pandemic Lockdown Parallels Population Activity Levels. Cerebrovasc Dis 2021; 50:317-325. [PMID: 33540410 PMCID: PMC7900457 DOI: 10.1159/000514154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background The COVID-19 pandemic lockdown (CPL) lead to a significant decrease in emergency admissions worldwide. We performed a timely analysis of ischemic stroke (IS) and related consultations using the telestroke TEMPiS “working diagnosis” database prior (PL), within (WL), and after easing (EL) of CPL. Methods Twelve hospitals were selected and data analyzed regarding IS (including intravenous thrombolysis [intravenous recombinant tissue plasminogen; IV rtPA] and endovascular thrombectomy [EVT]) and related events from February 1 to June 15 during 2017–2020. In addition, we aimed to correlate events to various mobile phone mobility data. Results Following the significant reduction of IS, IV rtPA, and EVT cases during WL compared to PL in 2020 longitudinally (p values <0.048), we observed increasing numbers of consultations, IS, recommendations for EVT, and IV rtPA with the network in EL over WL not reaching PL levels yet. Absolute numbers of all consultations paralleled best to mobility data of public transportation over walking and driving mobility. Conclusions While the decrease in emergency admissions including stroke during CPL can only be in part attributed by patients not seeking medical attention, stroke awareness in the pandemic, and direct COVID-19 triggered stroke remains of high importance. The number of consultations in TEMPiS during the lockdown parallels best with mobility of public transportation. As a consequence, exposure to common viruses, well-known triggers for acute cerebrovascular events and other diseases, are reduced and may add to the decline in stroke consultations. Further studies comparing national responses toward the course of the COVID-19 pandemic and stroke incidences are needed.
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Affiliation(s)
- Felix Schlachetzki
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany,
| | - Sibylle Wilfling
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Nikolai Dominik Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
| | - Andrea Wagner
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Roman L Haberl
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
| | - Ralf Andreas Linker
- Department of Neurology, TEMPiS Telemedical Stroke Center, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Gordian Jan Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, Academic Teaching Hospital of the University of Munich, München Klinik Harlaching, Munich, Germany
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Lou M, Yuan D, Liao S, Tong L, Li J. Potential mechanisms of cerebrovascular diseases in COVID-19 patients. J Neurovirol 2021; 27:35-51. [PMID: 33534131 PMCID: PMC7856859 DOI: 10.1007/s13365-021-00948-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023]
Abstract
Since the outbreak of coronavirus disease 2019 (COVID-19) in 2019, it is gaining worldwide attention at the moment. Apart from respiratory manifestations, neurological dysfunction in COVID-19 patients, especially the occurrence of cerebrovascular diseases (CVD), has been intensively investigated. In this review, the effects of COVID-19 infection on CVD were summarized as follows: (I) angiotensin-converting enzyme 2 (ACE2) may be involved in the attack on vascular endothelial cells by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to endothelial damage and increased subintimal inflammation, which are followed by hemorrhage or thrombosis; (II) SARS-CoV-2 could alter the expression/activity of ACE2, consequently resulting in the disruption of renin-angiotensin system which is associated with the occurrence and progression of atherosclerosis; (III) upregulation of neutrophil extracellular traps has been detected in COVID-19 patients, which is closely associated with immunothrombosis; (IV) the inflammatory cascade induced by SARS-CoV-2 often leads to hypercoagulability and promotes the formation and progress of atherosclerosis; (V) antiphospholipid antibodies are also detected in plasma of some severe cases, which aggravate the thrombosis through the formation of immune complexes; (VI) hyperglycemia in COVID-19 patients may trigger CVD by increasing oxidative stress and blood viscosity; (VII) the COVID-19 outbreak is a global emergency and causes psychological stress, which could be a potential risk factor of CVD as coagulation, and fibrinolysis may be affected. In this review, we aimed to further our understanding of CVD-associated COVID-19 infection, which could improve the therapeutic outcomes of patients. Personalized treatments should be offered to COVID-19 patients at greater risk for stroke in future clinical practice.
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Affiliation(s)
- Manxue Lou
- Department of Neurology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Dezhi Yuan
- Department of Neurology, First Affiliated Hospital of Army Medical University (Chongqing Southwest Hospital), Chongqing, 400038, China
- Department of Neurology, People's Hospital of Shapingba District, Chongqing, 400038, China
| | - Shengtao Liao
- Department of Gastroenterology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Linyan Tong
- Department of Neurology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jinfang Li
- Department of Neurology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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