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Stroke Acute Management and Outcomes During the COVID-19 Outbreak: A Cohort Study From the Madrid Stroke Network
Blanca Fuentes1, María Alonso de Leciñana1, Sebastián García-Madrona2
1Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain (B.F., M.A.d.L., G.R.-A., J.R.-P., E.D.T.).
Insights
COVID-19 patients experienced more severe strokes and poorer outcomes, despite similar acute care. Stroke networks maintained reperfusion therapies but longer door-to-puncture times occurred in COVID-19 cases.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic strained acute stroke care resources.
- Previous studies suggested more severe strokes in COVID-19 patients, but lacked comparative data.
- This study aimed to analyze the pandemic's impact on stroke care and outcomes.
Purpose of the Study:
- To assess the effect of the COVID-19 pandemic on acute stroke care delivery.
- To compare stroke outcomes between COVID-19 positive and negative patients.
- To identify factors influencing stroke severity and outcomes during the pandemic.
Main Methods:
- A retrospective multicenter cohort study of 550 acute stroke patients.
- Data collected from February 25 to April 25, 2020, during the initial Madrid outbreak.
- Stroke care quality measured by admissions, recanalization rates, and time metrics; primary outcome was death or dependence.
Main Results:
- A significant decrease in stroke admissions and interhospital transfers was observed.
- COVID-19 was confirmed in 19.1% of patients; outcomes were poorer for confirmed/suspected cases (aOR 2.05-3.56).
- Reperfusion therapy rates were similar, but COVID-19 patients had longer door-to-puncture times (110 vs. 80 min).
Conclusions:
- COVID-19 patients present with more severe strokes and worse outcomes, irrespective of acute management.
- Established stroke networks mitigated some pandemic impacts, maintaining reperfusion therapies.
- Increased door-to-puncture times in COVID-19 patients were linked to chest CT imaging.
Background And Purpose:
The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non-COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19.
Methods:
Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge.
Results:
A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non-COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P=0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12-3.76] and 3.56 [95% CI, 1.15-11.05], respectively).
Conclusions:
This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.
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