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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Reduction in Acute Stroke Admissions during the COVID-19 Pandemic: Data from a National Stroke Registry
Carmit Libruder1, Amit Ram1, Yael Hershkovitz1
1Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
Insights
The COVID-19 pandemic led to a significant drop in hospital admissions for stroke and TIA. Patients avoided seeking urgent care, potentially missing life-saving treatments.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic strained global healthcare systems.
- Disruptions impacted care for non-COVID-19 acute conditions, including stroke.
Purpose of the Study:
- To assess the impact of the COVID-19 outbreak on acute stroke and transient ischemic attack (TIA) admissions.
- To evaluate changes in in-hospital stroke care during the early pandemic in Israel.
Main Methods:
- Retrospective observational study using data from the Israeli National Stroke Registry (January-April 2020).
- Comparison of hospitalizations, demographics, and stroke care parameters between pre-pandemic and pandemic periods.
- Stratification of data based on COVID-19 restriction timelines.
Main Results:
- A significant decrease in hospital admissions: 48% for TIA and 29% for stroke.
- No major changes in demographic characteristics or most stroke management parameters.
- Reperfusion therapy rates remained stable, but absolute numbers decreased; higher mortality noted for hemorrhagic stroke.
Conclusions:
- A substantial decline in stroke and TIA admissions occurred early in the pandemic, even with low COVID-19 burden.
- Public awareness is crucial to encourage timely stroke care seeking, preventing loss of treatments and secondary prevention.
Introduction:
The COVID-19 pandemic overwhelmed health-care systems worldwide, and medical care for other acute diseases was negatively impacted. We aimed to investigate the effect of the COVID-19 outbreak on admission rates and in-hospital care for acute stroke and transient ischemic attack (TIA) in Israel, shortly after the start of the pandemic.
Methods:
We conducted a retrospective observational study, based on data reported to the Israeli National Stroke Registry from 7 tertiary hospitals. All hospital admissions for acute stroke or TIA that occurred between January 1 and April 30, 2020 were included. Data were stratified into 2 periods according to the timing of COVID-19 restrictions as follows: (1) "pre-pandemic" - January 1 to March 7, 2020 and (2) "pandemic" - March 8 to April 30, 2020. We compared the weekly counts of hospitalizations between the 2 periods. We further investigated changes in demographic characteristics and in some key parameters of stroke care, including the percentage of reperfusion therapies performed, time from hospital arrival to brain imaging and to thrombolysis, length of hospital stay, and in-hospital mortality.
Results:
2,260 cases were included: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period. Hospital admissions significantly declined between the 2 periods, by 48% for TIA (rate ratio [RR] = 0.52; 95% CI 0.43-0.64) and by 29% for stroke (RR = 0.71; 95% CI 0.64-0.78). No significant changes were detected in demographic characteristics and in most parameters of stroke management. While the percentage of reperfusion therapies performed remained unchanged, the absolute number of patients treated with reperfusion therapies seemed to decrease. Higher in-hospital mortality was observed only for hemorrhagic stroke.
Conclusion:
The marked decrease in admissions for acute stroke and TIA, occurring at a time of a relatively low burden of COVID-19, is of great concern. Public awareness campaigns are needed as patients reluctant to seek urgent stroke care are deprived of lifesaving procedures and secondary prevention treatments.
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