Registry data elucidate risk factors for inpatient stroke in COVID-19
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The overall prevalence of new inpatient stroke in COVID-19 remained low, but age, male sex, hypertension, atrial fibrillation and diabetes conferred elevated risk, a speaker reported.
Using data from the American Heart Association’s COVID-19 CVD registry powered by Get With the Guidelines, researchers assessed risk factors for and overall prevalence of new ischemic stroke in COVID-19 infection requiring hospitalization. The findings were presented at the virtual International Stroke Conference.
“These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” Saate S. Shakil, MD, cardiology fellow at the University of Washington in Seattle, said in a press release. “As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems.”
Researchers utilized the AHA’s COVID-19 CVD registry to evaluate 21,073 patients with COVID-19 at 160 hospitals from March to November 2020 to determine common baseline characteristics, frequency of stroke, death and length of hospital stay.
The prevalence of new acute ischemic stroke was 0.75% for the entire cohort, and, according to the presentation, lower compared with prior studies.
Among patients with COVID-19 requiring hospitalization, new ischemic stroke was most prevalent in:
- men (stroke, 63.1%; no stroke, 53.9%);
- older patients (mean age in stroke, 65 years; mean age in no stroke, 61 years);
- patients with hypertension (P < .0001);
- patients with diabetes (P < .011); and
- patients with AF/atrial flutter (P < .0001).
“Hypertension was extremely prevalent in the COVID-19 registry at large, nearing 60% among patients who did not have a stroke, but also extremely prevalent among patients who did have a stroke, at 80%,” Shakil said during a press conference.
In addition, patients who were hospitalized with COVID-19 and experienced ischemic stroke were at great risk for critical illness resulting in ICU admission, mechanical ventilation and new renal replacement compared with those without stroke (P for all < .0001).
Researchers observed that patients who experienced stroke experienced a more than twofold length of hospital stay and twice the risk for inpatient death (P for both < .0001).
Among those included in the AHA COVID-19 CVD registry, approximately 26% were non-Hispanic Black patients, who accounted for 31% of cases of ischemic stroke. Risk for in-hospital ischemic stroke was greater among non-Hispanic Black patients compared with other racial/ethnic groups.
“Interestingly, this trend appears to be reversed among Hispanic patients, while among non-Hispanic white patients, their representation among ischemic stroke patients is similar to their overall representation in this COVID-19 registry,” Shakil said during the press conference.
“However ... these are for all-comers in each respective race or ethnicity group, not adjusting for baseline demographic factors or baseline comorbidities,” Shakil said during the press conference. “We will plan to do further analysis to understand the drivers of these disparities.”
After the press conference, AHA President Mitchell S.V. Elkind, MD, MS, FAAN, FAHA, professor of neurology and epidemiology at Columbia University Irving Medical Center and attending neurologist at NewYork-Presbyterian Hospital, discussed the utility of Get With the Guidelines in circumstances such as the COVID-19 pandemic.
“Almost 2,000 hospitals participate in Get With the Guidelines – Stroke and it’s been going on for about 18 years; we have 5 million patient records enrolled; or just over 80% of all strokes that occur in the United States get entered into the registry,” Elkind said. “Having this infrastructure from Get With the Guidelines – Stroke, as well as our other Get With the Guidelines registries, gives us the ability to build a registry like the one presented by Dr. Shakil. This speaks to the ability of the AHA to respond quickly to a crisis like the COVID-19 pandemic.”
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Shakil S, et al. Late-Breaking Science XII. Presented at: International Stroke Conference; March 17-19, 2021 (virtual meeting).
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