Global Stroke Care Takes a Hit During the Pandemic

The COVID-19 pandemic was linked with a global decline in the volume of stroke hospitalizations, intravenous thrombolysis (IVT), and interfacility IVT transfers, a researcher reported.

From March to June 2020, stroke admissions declined by 11.5% at 457 worldwide centers versus 4 months immediately before the pandemic, according to Thanh Nguyen, MD, of Boston University School of Medicine and Boston Medical Center.

There were 91,373 stroke admissions in the 4 months immediately before the pandemic was declared versus 80,894 admissions during the pandemic months (P<0.0001), she said in a presentation at the American Academy of Neurology (AAN) virtual meeting.

Nguyen and colleagues also reported a drop in the rate of IVT attempts at 13,334 in the 4 months preceding compared with 11,570 procedures during the pandemic, for a 13.2% reduction (P<0.0001). In addition, interfacility IVT transfers decreased 11.9% from 1,337 to 1,178 (P=0.001).

The investigators did find a recovery of stroke hospitalization volume by 9.5% over the 2 later months (May/June) versus the 2 earlier months (March/April) of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and in comprehensive stroke centers (P<0.0001).

There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% of all stroke admissions for 1,722 infections among 52,026 stroke patients.

“There are many reasons we believe that may be behind the declines in stroke admissions,” Nguyen said. “Fear of contracting COVID-19 or nosocomial infection during the hospitalization is cited as a very common reason across many publications; a reduction in exposure to other infections as we wear masks can also potentially reduce out risk of having stroke, and potentially as we shut down elective surgeries and patients, we may have a decline because there are less perioperative strokes.”

She speculated that a silver lining could be that people are having fewer strokes because they are developing healthier habits during the pandemic.

The cross-sectional, observational, retrospective study was done across six continents and 70 countries with 450 co-authors. AAN press conference moderator Natalia Rost, MD, of Massachusetts General Hospital in Boston, said she was impressed by the study’s scope.

“This is one of the most impressive global stroke collaborations I’ve ever encountered in my career,” Rost, who is chair of the AAN science committee, told MedPage Today. “Both the scope of the collaboration and the quality of data submitted were outstanding, and it’s a true testament to the global community of stroke neurologists being prepared to address the issues related to stroke care — whether diagnosis, treatments, or quality of care — even under the duress of this pandemic.”

“Clearly, ‘it takes a village’ to address some of the key scientific challenges of our times, and especially, this approach was important to address the link between COVID-19 infection and stroke,” Rost said. “Obviously, this story continues to evolve and we are looking forward to future studies from this group and others to further this knowledge.”

The study was prompted by early reports about declines in acute stroke care in local, regional, and national studies. “However, these reports originated from highly resourced countries, such as the United States, China, France, Germany, Spain, and Italy,” Nguyen said. “As the pandemic takes on a global spread, we sought to understand the effect of the COVID-19 epidemic on stroke care, acute stroke treatment with thrombolysis, and intravenous thrombolysis transfer across centers across the globe in low- and middle-income countries, high rate stroke centers, and centers with low COVID-19 burden.” Countries involved in the current study included Cameroon, Zambia, Nigeria, Egypt, and India.

Nguyen explained that her group did not evaluate the severity grades of stroke “because in doing a global study, we had to ask what was a reasonable amount of data to request from our co-authors.”

She added that the investigators continue to explore the data to determine if the vaccine rollout will impact stroke admissions, and also will do a comparison of a year’s worth of data before and during the pandemic.