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Chen Y, Nguyen TN, Siegler JE, Mofatteh M, Wellington J, Yang R, Zeng L, Wu J, Sun X, Liang D, Tang Q, Chen S, Huang X, Yang S, Liao X. The Impact of COVID-19 Pandemic on Ischemic Stroke Patients in a Comprehensive Hospital. Risk Manag Healthc Policy 2022; 15:1741-1749. [PMID: 36124298 PMCID: PMC9482438 DOI: 10.2147/rmhp.s380691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to investigate the impact of characteristic ischemic stroke and outcomes during the first COVID-19 pandemic lockdown. Patients and Methods A retrospective, observational cohort study of a comprehensive tertiary stroke center was conducted. Patients with ischemic stroke were divided into pre-COVID-19 lockdown (11/1/2019 to 1/30/2020) and COVID-19 lockdown (1/31/2020 to 4/30/2020) period groups. Patient data on stroke admission, thrombolysis, endovascular treatment, and 3-month routine follow-up were recorded. Data analysis was performed using SPSS according to values following a Gaussian distribution. Results The pre-COVID-19 lockdown period group comprised 230 patients compared to 215 patients in the COVID-19 lockdown period group. Atrial fibrillation was more predominant in the COVID-19 lockdown period group (11.68% vs 5.65%, p=0.02) alongside patients who were currently smoking (38.8% vs 28.7%, p=0.02) and drinking alcohol (30.37% vs 20.00%, p=0.012) compared with that of the pre-COVID-19 lockdown period group. For patients receiving thrombolysis, the median door-to-CT time was longer in the COVID-19 lockdown period group (17.0 min (13.0, 24.0) vs 12.0 min (8.0, 17.3), p=0.012), median door to needle time was 48.0 minutes (35.5, 73.0) vs 43.5 minutes (38.0, 53.3), p=0.50, compared with that of the pre-COVID-19 lockdown period group. There were no differences for patients receiving mechanical thrombectomy. The median length of hospitalization (IQR) was no different. Discharge mRS scores (IQR) were higher in the COVID-19 lockdown period group (1.0 (1.0, 3.0) vs 1.0 (1.0, 2.0), p=0.022). Compared with the pre-COVID-19 lockdown period, hospitalization cost (Chinese Yuan) in the COVID-19 period group was higher (13,445.7 (11,009.7, 20,030.5) vs 10,799.2 (8692.4, 16,381.7), p=0.000). There was no difference observed in 3-month mRS scores. Conclusion Patients presenting with ischemic stroke during the COVID-19 pandemic lockdown period had longer median door-to-CT time and higher hospitalization costs. There were no significant differences in 3-month outcomes. Multidisciplinary collaboration and continuous workflow optimization may maintain stroke care during the COVID-19 pandemic lockdown.
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Affiliation(s)
- Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston University School of Medicine, Boston, MA, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Rongshen Yang
- Medical Intern of Neurology Department, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,School of Medicine, Shaoguan University, Shaoguan, People's Republic of China
| | - Lihong Zeng
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China
| | - Jiale Wu
- Medical Intern of Neurology Department, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,School of Medicine, Shaoguan University, Shaoguan, People's Republic of China
| | - Xi Sun
- Medical Intern of Neurology Department, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,School of Medicine, Shaoguan University, Shaoguan, People's Republic of China
| | - Daiyu Liang
- Medical Intern of Neurology Department, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,School of Medicine, Shaoguan University, Shaoguan, People's Republic of China
| | - Qiubi Tang
- Chronic Disease Department, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Sijie Chen
- Medical Intern of Neurology Department, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,School of Medicine, Shaoguan University, Shaoguan, People's Republic of China
| | - Xisheng Huang
- Medical Intern of Neurology Department, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,School of Medicine, Shaoguan University, Shaoguan, People's Republic of China
| | - Shuiquan Yang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China
| | - Xuxing Liao
- Dean Office and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, People's Republic of China.,Department of Neurosurgery, First People's Hospital of Foshan, Foshan, People's Republic of China
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Chmiela T, Rzepka M, Kuca M, Serwońska K, Laskowski M, Koperczak A, Siuda J. Intravenous Thrombolysis for Acute Ischemic Stroke during the COVID-19 Pandemic-Polish Single-Center Retrospective Cohort Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071068. [PMID: 35888156 PMCID: PMC9321477 DOI: 10.3390/life12071068] [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: 06/14/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
COVID-19 has affected the entire world and has had a great impact on healthcare, influencing the treatment of patients with acute ischemic stroke (AIS). The aim of this study was to determine the impact of the COVID-19 pandemic on the care of patients with AIS. We performed a retrospective analysis of 1599 patients diagnosed with AIS and hospitalized in the authors' institution from January 2018 to December 2021. The final sample consisted of 265 patients treated with thrombolysis without a diagnosis of COVID-19. The initiation of thrombolytic treatment during the pandemic was delayed (2:42 ± 0:51 vs. 2:25 ± 0:53; p = 0.0006). The delay was mainly related to the pre-hospital phase (1:41 ± 0:48 vs. 1:26 ± 0:49; p = 0.0014), and the door-to-needle time was not affected. There were no differences in stroke severity and patients' outcomes. Patients with AIS were less likely to have previously been diagnosed with atrial fibrillation (16.9% vs. 26.7%; p = 0.0383), ischemic heart disease (25.3% vs. 46.5%; p = 0.0003) and hyperlipidemia (31.2% vs. 46.5%; p = 0.0264). Patients treated during the pandemic had higher glycemia (149.45 ± 54. vs. 143.25 ± 60.71 mg/dL; p= 0.0012), while no significant differences in their lipid profiles were found. Conclusions: The COVID-19 pandemic affected the treatment of AIS patients locally at our stroke center. It caused treatment delay and hindered the recognition of risk factors prior to the occurrence of AIS.
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Affiliation(s)
- Tomasz Chmiela
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (J.S.)
- Correspondence:
| | - Michalina Rzepka
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (J.S.)
| | - Maciej Kuca
- Students’ Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.K.); (K.S.); (M.L.); (A.K.)
| | - Karolina Serwońska
- Students’ Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.K.); (K.S.); (M.L.); (A.K.)
| | - Maciej Laskowski
- Students’ Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.K.); (K.S.); (M.L.); (A.K.)
| | - Agnieszka Koperczak
- Students’ Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.K.); (K.S.); (M.L.); (A.K.)
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (M.R.); (J.S.)
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Mahmoud K, Jaramillo C, Barteit S. Telemedicine in Low- and Middle-Income Countries During the COVID-19 Pandemic: A Scoping Review. Front Public Health 2022; 10:914423. [PMID: 35812479 PMCID: PMC9257012 DOI: 10.3389/fpubh.2022.914423] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background COVID-19 has impacted the capacity of healthcare systems worldwide, particularly in low- and middle-income countries (LMICs), which are already under strain due to population growth and insufficient resources. Since the COVID-19 pandemic's emergence, there has been an urgent need for a rapid and adequate reaction to the pandemic's disruption of healthcare systems. To this end, telemedicine has been shown in prior research to be a feasible approach. The overarching objective of this scoping review was to determine the extent and acceptance of telemedicine in healthcare in low- and middle-income countries (LMICs) during the COVID-19 pandemic. Methods This scoping review followed PRISMA guidelines and Arksey and O'Malley's five-stage framework to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between January 2020 and April 2021: Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for grey literature. Results The search identified 54 articles with 45,843 participants, including 6,966 healthcare professionals and 36,877 healthcare users. We identified a range of reasons for introducing telemedicine in LMICs during COVID-19, most notably to maintain non-emergency healthcare, enhance access to healthcare providers, and reduce the risk of infection among health users and providers. Overall, healthcare providers and users have shown a high level of acceptance for telemedicine services. During the COVID-19 pandemic, telemedicine provided access to healthcare in the majority of included articles. Nonetheless, some challenges to accepting telemedicine as a method of healthcare delivery have been reported, including technological, regulatory, and economical challenges. Conclusion Telemedicine was found to improve access to high-quality healthcare and decrease infection risk in LMICs during COVID-19. In general, infrastructure and regulatory barriers found to be the most significant barriers to wider telemedicine use, and should be considered when implementing telemedicine more broadly. There appears to be a need to prioritize patient data safety, as many healthcare practitioners utilized commercial apps and services as telemedicine systems. Additionally, it appears as though there is a need to increase capacity, skill, and transparency, as well as to educate patients about telemedicine.
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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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