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Kim J, Olaiya MT, De Silva DA, Norrving B, Bosch J, De Sousa DA, Christensen HK, Ranta A, Donnan GA, Feigin V, Martins S, Schwamm LH, Werring DJ, Howard G, Owolabi M, Pandian J, Mikulik R, Thayabaranathan T, Cadilhac DA. Global stroke statistics 2023: Availability of reperfusion services around the world. Int J Stroke 2024; 19:253-270. [PMID: 37853529 PMCID: PMC10903148 DOI: 10.1177/17474930231210448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed. AIMS To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services. METHODS We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary. RESULTS Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world. CONCLUSION Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jackie Bosch
- School of Rehabilitation Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Diana A De Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Hanne K Christensen
- Department of Neurology, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
| | - Geoffrey A Donnan
- Melbourne Brain Centre, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - George Howard
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Robert Mikulik
- Health Management Institute, Brno, Czech Republic
- Neurology Department, Bata Hospital, Zlin, Czech Republic
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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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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Sedova P, Kent JA, Bryndziar T, Jarkovsky J, Tomek A, Sramek M, Skoda O, Sramkova T, Pokorová K, Littnerova S, Brown RD, Mikulik R. The decline in stroke hospitalization due to COVID-19 is unrelated to COVID-19 intensity. Eur J Neurol 2023; 30:943-950. [PMID: 36511840 PMCID: PMC9877601 DOI: 10.1111/ene.15664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE During the coronavirus disease 2019 (COVID-19) pandemic many countries reported a decline in stroke volumes. The aim of this study was to analyze if the decline was related to the intensity of the COVID-19 pandemic. METHODS The first pandemic year (1 March 2020 to 28 February 2021) overall and during the three COVID-19 waves were compared with the preceding year. Volumes of acute ischaemic stroke (AIS), subarachnoid hemorrhage, intracerebral hemorrhage and recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) were obtained from the National Register of Reimbursed Health Services. Door-to-needle time, onset-to-door time and National Institutes of Health Stroke Scale at admission were obtained from the Registry of Stroke Care Quality. RESULTS During the pandemic year compared to the preceding year there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p < 0.001). The declines (-10%, -11%, -19%) appeared in COVID-19 waves (spring 2020, autumn 2020, winter 2021) except for an increase (2%) during summer 2020. Admissions for AIS declined by 10.2% (p < 0.001), whilst hemorrhagic stroke volumes were minimally decreased. The absolute volumes of IVT and MT decreased by 9.4% (p < 0.001) and 5.7% (p = 0.16), respectively. However, the proportions of ischaemic stroke patients receiving IVT (18% vs. 18%; p = 0.72) and MT (6% vs. 6%; p = 0.28) remained unchanged. CONCLUSIONS There was a decline in stroke admissions, but such decline was not related to COVID-19 incidence. The frequency of use of recanalization procedures (IVT, MT) and times (onset-to-door time, door-to-needle time) in AIS were preserved in the Czech Republic during the first year of the pandemic.
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Affiliation(s)
- Petra Sedova
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- International Clinical Research CenterSt Anne's University HospitalBrnoCzech Republic
- Department of Internal Medicine and CardiologyUniversity Hospital Brno and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
- Department of NeurologySt Anne's University Hospital, and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
| | | | - Tomas Bryndziar
- International Clinical Research CenterSt Anne's University HospitalBrnoCzech Republic
- Department of NeurologySt Anne's University Hospital, and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
- Faculty of MedicineInstitute of Biostatistics and Analyses, Masaryk UniversityBrnoCzech Republic
| | - Ales Tomek
- Department of NeurologyCharles University in Prague, and Second Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Martin Sramek
- Department of NeurologyCharles University in Prague, and Second Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Ondrej Skoda
- Neurological Department and Stroke UnitJihlava HospitalJihlavaCzech Republic
- Department of NeurologyUniversity Hospital Kralovske Vinohrady and Charles University in PraguePragueCzech Republic
| | - Tereza Sramkova
- Department of NeurologyCharles University in Prague, and Second Faculty of Medicine and Motol University HospitalPragueCzech Republic
| | - Kateřina Pokorová
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
- Faculty of MedicineInstitute of Biostatistics and Analyses, Masaryk UniversityBrnoCzech Republic
| | - Simona Littnerova
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
- Faculty of MedicineInstitute of Biostatistics and Analyses, Masaryk UniversityBrnoCzech Republic
| | | | - Robert Mikulik
- International Clinical Research CenterSt Anne's University HospitalBrnoCzech Republic
- Department of NeurologySt Anne's University Hospital, and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
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Gdovinova Z, Kovačik M, Urbani D. How stroke care has changed in Slovakia in the last 5 years. Eur Stroke J 2023; 8:52-58. [PMID: 36793747 PMCID: PMC9923130 DOI: 10.1177/23969873221115457] [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: 05/19/2022] [Accepted: 06/24/2022] [Indexed: 02/12/2023] Open
Abstract
Introduction Although stroke patients in Slovakia had been treated according to European recommendations, no network of primary and comprehensive stroke centers had been officially established; the ESO recommended quality parameters had not been fulfilled. Therefore, the Slovak Stroke Society decided to change the stroke management concept and introduced mandatory evaluation of quality parameters. This article focuses on key success factors of the change in stroke management in Slovakia and presents the 5-year results and perspectives for the future. Material and methods We processed data from the stroke register at the National Health Information Center, which is mandatory in Slovakia for all hospitals designated as primary and secondary stroke care centers. Results Since 2016, we have started to change stroke management. New National Guideline for Stroke Care was prepared in 2017 and published in 2018 as a Recommendation of the Ministry of Health of the Slovak Republic. The recommendation included pre-hospital as well as in-hospital stroke care, a network of primary stroke centers (hospitals administering intravenous thrombolysis - 37), and secondary stroke centers (hospitals treating with intravenous thrombolysis + endovascular treatment (ET) - 6). A stroke priority was instituted, having equally high priority as myocardial infarction. More efficient in-hospital workflow and pre-hospital patient triage shortened the time to treatment. Prenotification became mandatory in all hospitals. Non-contrast CT, and CT angiography is mandatory in all hospitals. In patients with suspected proximal large-vessel occlusion the EMS stays at the CT facility in primary stroke centers until the CT angiography is finished. If LVO is confirmed, the patient is transported to an EVT secondary stroke center by the same EMS. From 2019 all secondary stroke centers offer endovascular thrombectomy in a 24/7/365 system. We consider the introduction of quality control one of the most critical steps in stroke management. The result of these activities is 25.2% of patients treated with IVT and 10.2% by endovascular treatment, and median DNT 30 min. Number of patients screened for dysphagia increased from 26.4% in 2019 to 85.9% in 2020. In the most of the hospitals the proportion of ischemic stroke patients discharged with antiplatelets and in case of AF with anticoagulants was >85%. Discussion Our results indicate that it is possible to change stroke management at a single hospital and national level. For continuous and further improvement, regular quality monitoring is necessary; therefore, the results of stroke hospital management are presented regularly once a year at national and international level. Collaboration with the "Second for Life" patient organization is very important for the "time is brain" campaign in Slovakia. Conclusion Due to the change in stroke management over the last 5 years, we have reduced the time for acute stroke treatment and improved the proportion of patients with acute treatment, and in this area, we have achieved and exceeded the goals of the Stroke Action Plan for Europe for 2018-2030. Nevertheless, we still have many insufficiencies in stroke rehabilitation and post-stroke nursing that need to be addressed.
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Affiliation(s)
- Zuzana Gdovinova
- Department of Neurology, Faculty of Medicine,
Pavol Jozef Šafárik University Kosice, Kosice, Slovakia,Zuzana Gdovinova, Department of Neurology, Faculty
of Medicine, Pavol Jozef Šafárik University Kosice, Trieda SNP 1, Kosice 04011, Slovakia.
| | - Michal Kovačik
- Ivan Stodola Liptovsky Hospital With
Polyclinics, Liptovsky Mikulas, Žilina Region, Slovakia
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Gdovinová Z, Vitková M, Baráková A, Cvopová A. Did the severity of the COVID-19 outbreak affect the quality of acute stroke care? (Data from across the country). Eur Stroke J 2022; 7:175-179. [PMID: 35647318 PMCID: PMC9134781 DOI: 10.1177/23969873221089426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/05/2022] [Indexed: 09/17/2023] Open
Abstract
Introduction The aim of our study was to determine whether the severity of the COVID-19 pandemic affected the quality of acute care of stroke. Methods Data from the stroke register at the National Health Information Centre were analysed. Clinical data from two time periods (the first wave: March-April 2020; the second wave: October-November 2020) were compared using an independent sample t-test and the Wilcoxon-Mann-Whitney two sample rank-sum test. Results The total number of patients admitted with stroke during the second wave of COVID-19 was 1848, versus 1698 in the first wave. The proportion of patients treated by IVT was similar in both waves (275 (20.7%) vs 333 (22.1%), p = 1, difference in location: -0,0003, 95% CI: -5.0 to 5.95). We found no difference in time from the onset of symptoms to treatment (median = 130 min in both waves, p = 0.52, difference in location: 3.99, 95% CI: -6.0 to 14.0), nor in the door-to-needle time (median = 29 vs 30 min, p = 0.08, difference in location: -2.99, 95% CI: -5.0 to 0.008) between the first and the second waves of the pandemic. We found no difference in NIHSS (median = 3 vs 4, p = 0.51, difference in location: 0.00007, 95% CI: -0.9 to 0.000006) and mRS (median = 3 in both waves, p = 0.60, difference in location: -0.00004, 95% CI: -0.00004 to 0.00003) at discharge from hospital between the two periods. Conclusion The severity of the COVID-19 outbreak did not affect the quality of acute stroke care in Slovakia.
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Affiliation(s)
- Zuzana Gdovinová
- Department of Neurology, Faculty of
Medicine, P.J. Safarik University and University Hospital L. Pasteur, Košice,
Slovakia
| | - Marianna Vitková
- Department of Neurology, Faculty of
Medicine, P.J. Safarik University and University Hospital L. Pasteur, Košice,
Slovakia
| | - Anna Baráková
- National Health Information Centre,
Bratislava, Slovakia
| | - Alena Cvopová
- National Health Information Centre,
Bratislava, Slovakia
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Ishaque N, Butt AJ, Kamtchum-Tatuene J, Nomani AZ, Razzaq S, Fatima N, Vekhande C, Nair R, Akhtar N, Khan K, Saqqur M, Shuaib A. Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis. J Stroke 2022; 24:65-78. [PMID: 35135061 PMCID: PMC8829489 DOI: 10.5853/jos.2021.01571] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy.Methods Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models.Results We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively).Conclusions Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.
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Affiliation(s)
- Noman Ishaque
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Asif Javed Butt
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ali Zohair Nomani
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Red Deer Regional Hospital Center, Red Deer, AB, Canada
| | - Sarah Razzaq
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chetan Vekhande
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Radhika Nair
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naveed Akhtar
- Division of Neurology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Khurshid Khan
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neurology, Trillium Health Care, University of Toronto, Mississauga, ON, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Correspondence: Ashfaq Shuaib Division of Neurology, Department of Medicine, University of Alberta, Edmonton T6G 2G3, AB, Canada Tel: +1-780-248-1660 Fax: +1-780-248-1807 E-mail:
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7
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Impact of the COVID-19 lockdown on the adherence of stroke patients to direct oral anticoagulants: a secondary analysis from the MAAESTRO study. J Neurol 2022; 269:19-25. [PMID: 34081196 PMCID: PMC8173508 DOI: 10.1007/s00415-021-10631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The negative impact of the COVID-19 outbreak on stroke care has been reported, but no data exist on the influence of the lockdown on medication adherence to antithrombotic treatment for stroke prevention. We present a comparison of electronic adherence data of stroke patients treated with direct oral anticoagulants (DOAC) prior to and during the COVID-19 lockdown in spring 2020 in Switzerland. METHODS This is a secondary analysis using data from the ongoing MAAESTRO study, in which stroke patients with atrial fibrillation electronically monitor their adherence to DOAC treatment. Eligible patients for this analysis had at least four weeks of adherence data prior to and during the COVID-19 lockdown. Three adherence metrics (taking adherence, timing adherence, drug holidays) were calculated and compared descriptively. RESULTS The analysis included eight patients (median age 81.5 years, IQR 74.8-84.5). Five patients had a pre-lockdown taking adherence over 90% (mean 96.8% ± 2.9), with no change during lockdown, high timing adherence in both periods and no drug holidays. The remaining three patients had pre-lockdown taking and timing adherence below 90%. Of those, two patients showed a moderate decline either in taking or timing adherence compared to pre-lockdown. One showed a substantial increase in taking and timing adherence during lockdown (both + 25.8%). CONCLUSION Our data suggest that a major disruption of social life (i.e., the imposed COVID-19 lockdown) is unlikely to relevantly affect the medication intake behaviour of patients with high pre-established adherence, but might have an impact in patients with previously suboptimal adherence. TRIAL REGISTRATION NUMBER MAAESTRO: electronic Monitoring and improvement of Adherence to direct oral Anticoagulant treatment-a randomized crossover study of an Educational and reminder-based intervention in ischaemic STROke patients under polypharmacy, NCT03344146.
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Sellner J, Jenkins TM, von Oertzen TJ, Bassetti CL, Beghi E, Bereczki D, Bodini B, Cavallieri F, Di Liberto G, Helbok R, Macerollo A, Maia LF, Oreja‐Guevara C, Özturk S, Rakusa M, Pisani A, Priori A, Sauerbier A, Soffietti R, Taba P, Zedde M, Crean M, Burlica A, Twardzik A, Moro E. A plea for equitable global access to COVID-19 diagnostics, vaccination and therapy: The NeuroCOVID-19 Task Force of the European Academy of Neurology. Eur J Neurol 2021; 28:3849-3855. [PMID: 33460486 PMCID: PMC8014664 DOI: 10.1111/ene.14741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a multi-organ disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to challenge health and care systems around the globe. The pandemic has disrupted acute neurology services and routine patient care and has impacted the clinical course in patients with chronic neurological disease. COVID-19 appears to have exposed inequalities of societies and healthcare systems and had a disproportionate impact on already vulnerable communities. The next challenge will be to set up initiatives to stop disparities in all aspects related to COVID-19. From the medical perspective, there is a need to consider inequalities in prevention, treatment and long-term consequences. Some of the issues of direct relevance to neurologists are summarised. With this appraisal, the European Academy of Neurology NeuroCOVID-19 Task Force intends to raise awareness of the potential impact of COVID-19 on inequalities in healthcare and calls for action to prevent disparity at individual, national and supranational levels.
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Affiliation(s)
- Johann Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
- Department of NeurologyChristian Doppler Medical CenterParacelsus Medical UniversitySalzburgAustria
- Department of NeurologyKlinikum rechts der IsarTechnische Universität MünchenMünchenGermany
| | - Thomas M. Jenkins
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Tim J. von Oertzen
- Faculty of MedicineJohannes‐Kepler UniversitätLinzAustria
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
| | | | - Ettore Beghi
- Istituto di Ricerche Farmacologiche Mario NegriIRCCSMilanItaly
| | | | - Benedetta Bodini
- Department of NeurologySaint‐Antoine HospitalAPHPSorbonne UniversityParisFrance
| | - Francesco Cavallieri
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
| | - Giovanni Di Liberto
- Department of Clinical NeurosciencesCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland
| | - Raimund Helbok
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Antonella Macerollo
- Walton Centre NHS Foundation TrustLiverpoolUK
- School of PsychologyFaculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Luis F. Maia
- Department of NeurologyHospital Santo AntónioCentro Hospitalar Universitário do PortoPortoPortugal
- i3S ‐ Instituto de Investigação e Inovação em Saúde Universidade do PortoPortoPortugal
| | - Celia Oreja‐Guevara
- Department of NeurologyHospital Clinico San CarlosMadridSpain
- Departamento de MedicinaFacultad de MedicinaUniversidad Complutense de Madrid (UCMMadridSpain
- IdISSCMadridSpain
| | - Serefnur Özturk
- Department of NeurologyFaculty of MedicineSelcuk UniversityKonyaTurkey
| | - Martin Rakusa
- Department of NeurologyUniversity Medical Centre MariborMariborSlovenia
| | - Antonio Pisani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- IRCCS Mondino FoundationPaviaItaly
| | - Alberto Priori
- Division of NeurologyDepartment of Neurology‘Aldo Ravelli’ Research CenterUniversity of Milan and ASST Santi Paolo e CarloMilanItaly
| | - Anna Sauerbier
- Department of NeurologyUniversity Hospital CologneCologneGermany
- King's College HospitalNational Parkinson Foundation International Centre of ExcellenceLondonUK
| | - Riccardo Soffietti
- Division of Neuro‐OncologyDepartment of NeuroscienceUniversity of TurinTurinItaly
| | - Pille Taba
- Department of Neurology and NeurosurgeryInstitute of Clinical MedicineUniversity of TartuTartuEstonia
| | - Marialuisa Zedde
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
| | - Michael Crean
- European Academy of Neurology (EAN) Head OfficeViennaAustria
| | - Anja Burlica
- European Academy of Neurology (EAN) Head OfficeViennaAustria
| | - Alex Twardzik
- European Academy of Neurology (EAN) Head OfficeViennaAustria
| | - Elena Moro
- Division of NeurologyCHU of GrenobleGrenoble Institute of NeurosciencesGrenoble Alpes UniversityGrenobleFrance
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9
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Raymaekers V, Demeestere J, Bellante F, De Blauwe S, De Raedt S, Dusart A, Jodaitis L, Lemmens R, Loos C, Noémie L, Rutgers MP, Vandervorst F, Vanhooren G, Yperzeele L, Nogueira RG, Nguyen TN, Vanacker P. The impact of COVID-19 on acute stroke care in Belgium. Acta Neurol Belg 2021; 121:1251-1258. [PMID: 34148220 PMCID: PMC8214455 DOI: 10.1007/s13760-021-01726-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
A worldwide decline in stroke hospitalizations during the COVID-19 pandemic has been reported. Information on stroke care during the pandemic in Belgium is lacking. This study aims to analyze the impact of COVID-19 on acute stroke care in eight Belgian stroke centers. This Belgian study is part of an international observational and retrospective study in 70 countries and 457 stroke centers. We compared volumes of COVID-19 and stroke hospitalizations, intravenous thrombolysis and endovascular treatment rates, acute treatment time intervals and functional outcome at 90 days during the first wave of the pandemic to two control intervals (March–May 2019 and December–February 2020). From March 2020 to May 2020, 860 stroke patients were hospitalized. In the same time period, 2850 COVID-19 patients were admitted, of which 37 (1.3%) were diagnosed with a stroke. Compared to the months prior to the pandemic and the same time epoch one year earlier, stroke hospitalizations were reduced (relative difference 15.9% [p = 0.03] and 14.5% [p = 0.05], respectively). Despite a reduction in absolute volumes, there was no difference in the monthly proportion of thrombolysis or endovascular treatment provided to the overall stroke hospitalizations. Acute treatment time metrics did not change between COVID-19 pandemic and control time epochs. We found no difference in 90-day functional outcomes nor in mortality after stroke between patients admitted during the pandemic versus control periods. We found a decline in the volume of stroke hospitalizations during the first wave of the COVID-19 pandemic in Belgium. Stroke care quality parameters remained unchanged.
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Affiliation(s)
- Vincent Raymaekers
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium.
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.
| | - Jelle Demeestere
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Sofie De Blauwe
- Department of Neurology, Sint-Jan Hospital Bruges-Ostend, Bruges, Belgium
| | - Sylvie De Raedt
- Department of Neurology, University Hospital Brussels, Jette, Belgium
- Center of Neurosciences, University of Brussels, Brussels, Belgium
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Lise Jodaitis
- Department of Neurology, Erasmus Hospital, Brussels, Belgium
| | - Robin Lemmens
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Caroline Loos
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Ligot Noémie
- Department of Neurology, Erasmus Hospital, Brussels, Belgium
| | | | - Fenne Vandervorst
- Department of Neurology, University Hospital Brussels, Jette, Belgium
- Center of Neurosciences, University of Brussels, Brussels, Belgium
| | - Geert Vanhooren
- Department of Neurology, Sint-Jan Hospital Bruges-Ostend, Bruges, Belgium
| | - Laetitia Yperzeele
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Emory University, Atlanta, GA, USA
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Peter Vanacker
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
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10
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Sedova P, Brown Jr. RD, Bryndziar T, Jarkovsky J, Tomek A, Sramek M, Skoda O, Sramkova T, Littnerova S, Mikulik R. Treat COVID-19, but Not Only COVID-19: Stroke Matters as Well. Cerebrovasc Dis 2021; 51:52-59. [PMID: 34515067 PMCID: PMC8450853 DOI: 10.1159/000517968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, studies reported less number of hospitalizations for acute stroke and reduction in the use of recanalization treatments. This study analyzes nationwide data on stroke admissions and management in the Czech Republic during the first wave of the COVID-19 pandemic. METHODS We compared the early COVID-19 pandemic (March-May 2020) with the pre-pandemic period (January-February 2020 and March-May 2019): (a) the National Register of Reimbursed Health Services provided volume of all admissions for subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (IS), and volume of recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]); (b) Registry of Stroke Care Quality provided door-to-needle time (DNT), onset-to-door time (ODT), and stroke severity at admission (National Institutes of Health Stroke Scale, NIHSS) for IS. RESULTS During the pandemic (March-May 2020), the peak number of COVID-19 patients treated in Czech hospitals was 39 per million. In March-May 2020 versus March-May 2019, hospital admissions decreased as follows: stroke overall by 14% (p < 0.001), IS by 14% (p < 0.001), SAH by 15% (p = 0.07), and ICH by 7% (p = 0.17). The mean age was 74 years versus 74 years (p = 0.33), and 52% versus 51% were men (p = 0.34). The volumes of IVT and MT decreased by 14% (p = 0.001) and 19% (p = 0.01), respectively. The proportions of all IS patients receiving IVT or MT remained unchanged, with, respectively, 17% versus 17% receiving IVT (p = 0.86) and 5% versus 5% receiving MT (p = 0.48). DNT and ODT were 24 versus 25 min (p = 0.58) and 168 versus 156 min (p = 0.23), respectively. NIHSS at admission did not differ (6 vs. 6; p = 0.54). CONCLUSION Even with a low burden of COVID-19 during the first wave and no change in organization and logistics of stroke services, stroke admissions and volume of recanalization treatments decreased. Public health communication campaigns should encourage people to seek emergency medical care for stroke symptoms during the COVID-19 pandemic.
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Affiliation(s)
- Petra Sedova
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czechia
- Department of Neurology, St. Anne's University Hospital, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Tomas Bryndziar
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
- Department of Neurology, St. Anne's University Hospital, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Ales Tomek
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czechia
| | - Martin Sramek
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czechia
| | - Ondrej Skoda
- Neurological Department and Stroke Unit, Jihlava Hospital, Jihlava, Czechia
- Department of Neurology, University Hospital Kralovske Vinohrady and Charles University in Prague, Prague, Czechia
| | - Tereza Sramkova
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czechia
| | - Simona Littnerova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
- Department of Neurology, St. Anne's University Hospital, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
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