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The impact of COVID-19 on acute stroke care in Belgium
Vincent Raymaekers1,2, Jelle Demeestere3, Flavio Bellante4
1Department of Neurology, Groeninge Hospital, Kortrijk, Belgium. vincent.raymaekers@azgroeninge.be.
Insights
During the COVID-19 pandemic, Belgium saw a decline in stroke hospitalizations. However, stroke care quality, including treatment rates and patient outcomes, remained consistent.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Global reports indicate a decrease in stroke hospitalizations during the COVID-19 pandemic.
- Data on the impact of COVID-19 on acute stroke care in Belgium is limited.
- This study addresses the gap in understanding stroke care during the pandemic in Belgium.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on acute stroke care in eight Belgian stroke centers.
- To compare stroke hospitalization volumes, treatment rates, and patient outcomes during the pandemic's first wave with pre-pandemic periods.
- To assess changes in acute treatment times and 90-day functional outcomes for stroke patients.
Main Methods:
- An international, observational, retrospective study involving 457 stroke centers across 70 countries.
- Comparison of data from March-May 2020 (first COVID-19 wave) with two control periods: March-May 2019 and December 2019-February 2020.
- Analysis included stroke and COVID-19 hospitalization volumes, rates of intravenous thrombolysis and endovascular treatment, treatment time intervals, and 90-day functional outcomes.
Main Results:
- Stroke hospitalizations in Belgium decreased by 15.9% compared to pre-pandemic and 14.5% compared to the prior year.
- Despite reduced volumes, the proportion of stroke patients receiving thrombolysis or endovascular treatment remained stable.
- Acute treatment times and 90-day functional outcomes, including mortality, did not significantly differ between pandemic and control periods.
Conclusions:
- A significant decline in stroke hospitalizations occurred in Belgium during the initial phase of the COVID-19 pandemic.
- The quality of acute stroke care, measured by treatment rates and timeliness, was maintained.
- Patient outcomes after stroke did not worsen during the pandemic's first wave in Belgium.
Abstract:
A worldwide decline in stroke hospitalizations during the COVID-19 pandemic has been reported. Information on stroke care during the pandemic in Belgium is lacking. This study aims to analyze the impact of COVID-19 on acute stroke care in eight Belgian stroke centers. This Belgian study is part of an international observational and retrospective study in 70 countries and 457 stroke centers. We compared volumes of COVID-19 and stroke hospitalizations, intravenous thrombolysis and endovascular treatment rates, acute treatment time intervals and functional outcome at 90 days during the first wave of the pandemic to two control intervals (March-May 2019 and December-February 2020). From March 2020 to May 2020, 860 stroke patients were hospitalized. In the same time period, 2850 COVID-19 patients were admitted, of which 37 (1.3%) were diagnosed with a stroke. Compared to the months prior to the pandemic and the same time epoch one year earlier, stroke hospitalizations were reduced (relative difference 15.9% [p = 0.03] and 14.5% [p = 0.05], respectively). Despite a reduction in absolute volumes, there was no difference in the monthly proportion of thrombolysis or endovascular treatment provided to the overall stroke hospitalizations. Acute treatment time metrics did not change between COVID-19 pandemic and control time epochs. We found no difference in 90-day functional outcomes nor in mortality after stroke between patients admitted during the pandemic versus control periods. We found a decline in the volume of stroke hospitalizations during the first wave of the COVID-19 pandemic in Belgium. Stroke care quality parameters remained unchanged.
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