In older adults with COVID-19, stroke risk highest in first 3 days after diagnosis
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In older adults with COVID-19, ischemic stroke risk was much higher in the first 3 days after diagnosis than at points thereafter, researchers reported at the International Stroke Conference.
“The increased risk of ischemic stroke following COVID-19 may be one of the significant clinical findings related to COVID-19 that patients and clinicians should understand,” Quanhe Yang, PhD, senior scientist in the CDC’s Division for Heart Disease and Stroke Prevention, told Healio. “Our findings can inform the diagnosis, treatments and care of stroke among patients with COVID-19. Vaccination and other preventive measures for COVID-19 are important to reduce the risk of infection and complications including stroke.”
Yang and colleagues analyzed 37,379 Medicare beneficiaries aged 65 years or older (median age, 80 years; 57% women) diagnosed with COVID-19 from April 2020 to February 2021 and hospitalized for acute ischemic stroke from January 2019 to February 2021.
The study employed a self-controlled case series design and compared stroke risk in risk periods up to 28 days after COVID-19 diagnosis and other (control) periods.
“The findings of the association between COVID-19 and stroke remain inconsistent,” Yang told Healio. “Some studies found that COVID-19 is associated with increased risk of ischemic stroke, while other studies did not find such an association, and still other studies documented less than expected number of ischemic strokes among hospitalized patients with COVID-19. Few studies focused on the older population (age ≥ 65 years) where most stroke occurred. Differences in study designs, countries, inclusion criteria of patients and comparison groups, sample size and controlling for confounders may contribute to the inconsistent findings. The self-controlled case series study design is based on within-person comparisons (self-matched) after COVID-19 diagnosis during an observation period subdivided into risk and control periods; therefore, it implicitly controls for all fixed confounders during the period of study.”
According to the researchers, ischemic stroke risk was more than 10-fold higher in the first 3 days after COVID-19 diagnosis compared with control periods (incidence rate ratio [IRR] = 10.3; 95% CI, 9.86-10.8). When day 0 was excluded, the increase in risk was attenuated but remained significant (IRR = 1.77; 95% CI, 1.57-2.01).
Ischemic stroke risk was also elevated at 4 to 7 days (IRR = 1.61; 95% CI, 1.44-1.8), at 8 to 14 days (IRR = 1.44; 95% CI, 1.32-1.57) and 15 to 28 days (IRR = 1.09; 95% CI, 1.02-1.18), after COVID-19 diagnosis compared with control periods, Yang and colleagues found.
“COVID-19 is associated with increased risk of acute ischemic stroke in the first 3 days after diagnosis among Medicare fee-for-service beneficiaries at least 65 years of age,” Yang told Healio. “Stroke following COVID-19 is a possible complication of COVID-19 that patients and clinicians should understand.”
Reference:
- Stroke risk among older adults highest in first 3 days after COVID-19 diagnosis. newsroom.heart.org/news/stroke-risk-among-older-adults-highest-in-first-3-days-after-covid-19-diagnosis. Posted Feb. 3, 2022. Accessed Feb. 8, 2022.
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Yang Q, et al. Presentation TMP16. Presented at: International Stroke Conference; Feb. 9-11, 2022; New Orleans (hybrid meeting).
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