Outcomes of stroke care similar before, during COVID-19 pandemic
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At hospitals participating in Get With the Guidelines-Stroke, patients with acute ischemic stroke received similar quality care and had comparable outcomes before and during the COVID-19 pandemic.
“There were no differences in in-hospital mortality between those presenting with acute ischemic stroke pre- and during COVID-19,” Pratyaksh K. Srivastava, MD, cardiology fellow at the Ronald Reagan UCLA Medical Center, told Healio.
According to Srivastava, the COVID-19 pandemic has posed challenges for the delivery of acute stroke care. “We pursued this research in an attempt to better understand the impact of the pandemic on acute ischemic stroke management in the United States,” he said. “To do this, we used the national Get With the Guidelines-Stroke registry and compared characteristics, treatment patterns and outcomes between those who presented with acute ischemic stroke pre- and during COVID-19.”
For the retrospective, observational study, Srivastava and colleagues included 81,084 patients with acute ischemic stroke from 458 hospitals participating in Get With the Guidelines-Stroke. Researchers identified patients with acute ischemic stroke before (n = 39,113; November 2019 to Feb. 3, 2020) and after (n = 41,971; Feb. 4 to June 29, 2020) the first reported COVID-19 case in the registry. Of those in the latter arm, 2.7% had a diagnosis of COVID-19.
During the pandemic time period, weekly stroke presentations fell by an average of 15.3% compared with similar months in 2019. Researchers also found comparable rates and times of the following:
- IV alteplase: before, 11.7%; during, 11.4%; P = .26;
- endovascular therapy: before, 10.2%; during, 10.1%; P = .9;
- door to needle time: before, 46 minutes per person; during, 46 minutes per person; P = .69; and
- door to endovascular therapy time: before, 86 minutes per person; during, 90 minutes per person; P = .06.
Additionally, the door to CT time was slightly less during the pandemic timeframe (35 minutes per person vs. 37 minutes per person; P < .001).
In adjusted analysis, inpatient mortality did not differ between groups (before, 4.8%; during, 5.2%; OR = 1.05; 95% CI, 0.97-1.13; P = .22).
“These findings demonstrate that acute ischemic stroke care has not deteriorated during the pandemic for the general population, and reinforce the utility of national programs such as Get With the Guidelines-Stroke,” Srivastava said in an interview.
The researchers cautioned that the findings may not be generalizable to hospitals that differ from Get With the Guidelines-Stroke and international cohorts, and that the reported COVID-19 prevalence may be underestimated given that the availability and extent of COVID-19 testing at the participating hospitals is unknown.
For more information:
Pratyaksh K. Srivastava, MD, can be reached at psrivastava@mednet.ucla.edu; Twitter: @srivastavaprat.
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