Stroke Care in the United Kingdom During the COVID-19 Pandemic
Abdel Douiri1, Walter Muruet1, Ajay Bhalla1,2
1School of Population Health and Environmental Sciences (A.D., W.M., A.B., M.J., A.G.R., C.D.A.W., B.D.B.), King's College London, United Kingdom.
Insights
The COVID-19 pandemic reduced acute stroke admissions by 12%, with increased fatality despite preserved care quality. Hospital avoidance may have led to untreated strokes and poorer outcomes.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic impacted healthcare access, potentially harming patients with other conditions.
- Reduced healthcare access during the pandemic may have indirectly affected acute stroke patient care and outcomes.
Purpose of the Study:
- To assess the impact of the initial COVID-19 wave on acute stroke admissions.
- To evaluate changes in stroke care quality during the pandemic.
- To analyze the effect on patient outcomes for acute stroke.
Main Methods:
- A registry-based cohort study.
- Included patients with acute stroke admitted to hospitals in England, Wales, and Northern Ireland.
- Data collected from October 1, 2019, to April 30, 2020, compared with the 3 prior years.
Main Results:
- A 12% reduction in acute stroke admissions during the March 23 to April 30, 2020 lockdown period.
- Admissions decreased more for ischemic stroke, older patients, and less severe cases.
- While care quality measures were maintained or improved, 7-day inpatient fatality increased from 6.9% to 9.4%.
Conclusions:
- Hospital avoidance during the pandemic may have resulted in untreated stroke patients with poorer outcomes.
- Improvements in stroke care quality observed during the pandemic offer opportunities for future healthcare system development.
- Resilient healthcare systems are needed to manage future public health crises without compromising acute care.
Background And Purpose:
The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom.
Methods:
Registry-based cohort study of patients with acute stroke admitted to hospital in England, Wales, and Northern Ireland between October 1, 2019, and April 30, 2020, and equivalent periods in the 3 prior years.
Results:
One hundred fourteen hospitals provided data for a study cohort of 184 017 patients. During the lockdown period (March 23 to April 30), there was a 12% reduction (6923 versus 7902) in the number of admissions compared with the same period in the 3 previous years. Admissions fell more for ischemic than hemorrhagic stroke, for older patients, and for patients with less severe strokes. Quality of care was preserved for all measures and in some domains improved during lockdown (direct access to stroke unit care, 1-hour brain imaging, and swallow screening). Although there was no change in the proportion of patients discharged with good outcome (modified Rankin Scale score, ≤2; 48% versus 48%), 7-day inpatient case fatality increased from 6.9% to 9.4% (P<0.001) and was 22.0% in patients with confirmed or suspected COVID-19 (adjusted rate ratio, 1.41 [1.11-1.80]).
Conclusions:
Assuming that the true incidence of acute stroke did not change markedly during the pandemic, hospital avoidance may have created a cohort of untreated stroke patients at risk of poorer outcomes or recurrent events. Unanticipated improvements in stroke care quality should be used as an opportunity for quality improvement and to learn about how to develop resilient health care systems.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:29Venous Thrombosis III: Interprofessional Care
01:20Acute Kidney Injury V: Interprofessional Care