COVID-19 pandemic adversely affected cerebrovascular diagnoses

Diagnoses of cardiovascular issues plateaued during the COVID-19 pandemic, but diagnoses of cerebrovascular issues dropped sharply compared with pre-pandemic levels, per a population-based study published in Neurology.

The researchers studied data for one municipality in the Netherlands. They emphasized the need to improve recognition of symptoms among the general public and urged residents to seek out urgent care regardless of distance.

“The risk of severe health complications due to delays or failure in seeking medical attention increases when risk factors or warning signs of underlying diseases are left unheeded. This is particularly relevant for preventive care, or for symptoms that have been considered unimportant by patients due to incorrect perception of risk, as seems particularly the case for transient cerebrovascular symptoms,” Premysl Velek, MSc, from the department of epidemiology, Erasmus MC, University Medical Centre Rotterdam, and colleagues wrote.

Researchers sought to ascertain how the pandemic affected patients’ willingness to access care for potential stroke and heart attack symptoms in general practice, and how it affected diagnoses of the same with these medical professionals.

Information was pulled through accessing the electronic health records of 166,929 primary care patients aged 30 years or older within and adjacent to Rotterdam, a dense urban multicultural area, where the average distance to the nearest practice was 0.6 kilometers. The study period was Jan. 1, 2016, to Dec. 31, 2020.

Screening was performed to isolate only those consultations related to cerebrovascular and cardiovascular care, along with first diagnoses of selected cerebrovascular and cardiovascular risk factors (such as hypertension, diabetes and lipid disorders), conditions and events (such as angina, atrial fibrillation, trans-ischemic attack [TIA], myocardial infarction and stroke).

Researchers further quantified data by tracking changes in these outcomes during two COVID-19 surges (March to May 2020 and June to December 2020) and compared results against the same interval in 2016 to 2019. Estimates were also made for possible missed diagnoses for each outcome.

Results showed a sharp decline (38%) in the number of general practice consults for cerebrovascular and cardiovascular care during the first wave of the pandemic, weighed against expected amounts based on pre-pandemic levels. Precipitous declines were also revealed for new diagnoses of cerebrovascular issues: 37% for TIA, and 29% for stroke, but no significant deviations were discovered for cardiovascular events such as myocardial infarction or angina. Despite recovery of diagnosis counts after the first COVID-19 surge, the number of consultations for both categories were lower than expected for the entirety of the second wave.

“The decline in the number of first diagnoses of stroke and TIA calls for improvement of symptom recognition of cerebrovascular events among the general public and for awareness campaign to encourage urgent presentation despite any existing physical distancing measures,” Velek and colleagues wrote.

“The challenge for the near future is to identify patients who avoided health care and develop strategies for cerebrovascular and cardiovascular primary care that will minimize the consequences of undiagnosed risk factors and events during the COVID-19 pandemic,” they concluded.