Infectious Disease

Stroke care outcomes similar before during the COVID-19 pandemic

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Srivastava does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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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 was no difference in hospital mortality between those who presented with acute ischemic stroke before and during COVID-19,” Pratyaksh K. Srivastava, MD, a cardiologist at Ronald Reagan UCLA Medical Center, told Healio.

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. The data were provided by Srivastava PK et al. Stroke. 2021; doi: 10.1161 / STROKEAHA.120.034414.

According to Srivastava, the COVID-19 pandemic has challenged the delivery of acute stroke care. “We followed this research 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-Register and compared characteristics, treatment patterns and results between those who presented with an acute ischemic stroke before and during COVID-19.”

For the retrospective observational study, Srivastava and colleagues included 81,084 acute ischemic stroke patients from 458 hospitals who participated in Get With the Guidelines-Stroke. Researchers identified acute ischemic stroke patients before (n = 39,113; November 2019 to February 3, 2020) and after (n = 41,971; February 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 period, weekly stroke presentations decreased by an average of 15.3% compared to similar months in 2019. The researchers also found comparable rates and times for the following:

  • IV alteplase: previously 11.7%; while 11.4%; P = 0.26;
  • endovascular therapy: previously 10.2%; while 10.1%; P = 0.9;
  • Door-to-needle time: previously 46 minutes per person; while, 46 minutes per person; P = 0.69; and
  • Door to endovascular therapy Time: previously 86 minutes per person; for 90 minutes per person; P = 0.06.

In addition, the time to CT was slightly shorter during the pandemic period (35 minutes per person vs. 37 minutes per person; P <0.001).

In the adjusted analysis, inpatient mortality did not differ between the groups (previously 4.8%; during 5.2%; OR = 1.05; 95% CI 0.97–1.13; P = 0.22) .

“These results show that the treatment of acute ischemic stroke for the general population has not deteriorated during the pandemic and add to the benefits of national programs such as Get With the Guidelines-Stroke,” Srivastava said in an interview.

The researchers warned that the results may not be transferable to hospitals that differ from Get With the Guidelines-Stroke and international cohorts, and that reported COVID-19 prevalence could be underestimated as the availability and extent of COVID- 19 tests at the participating hospitals is unknown.

For more informations:

Pratyaksh K. Srivastava, MD can be reached at psrivastava@mednet.ucla.edu; Twitter: @srivastavaprat.

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