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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Social and clinical vulnerability in stroke and STEMI management during the COVID-19 pandemic: a registry-based study

Emilie Lesaine1,2, Florence Francis2,3, Sandrine Domecq4,2

  • 1CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France emilie.lesaine@u-bordeaux.fr.

BMJ Open
|January 3, 2024
PubMed

Insights

The COVID-19 pandemic did not worsen care for vulnerable stroke and STEMI patients, revealing pre-existing care inequalities. Emergency pathways remained structured during the crisis, with no significant changes observed for these patient groups.

Area of Science:

  • Neuroscience
  • Cardiology
  • Public Health

Background:

  • Vulnerable populations, including those with stroke and ST-segment elevation myocardial infarction (STEMI), may face disparities in healthcare access and quality.
  • The COVID-19 pandemic introduced unprecedented challenges to healthcare systems globally, potentially impacting the care of critically ill patients.

Purpose of the Study:

  • To assess if the first wave of the COVID-19 pandemic exacerbated existing care quality issues for socially and clinically vulnerable stroke and STEMI patients.
  • To analyze the impact of the pandemic on care management times for these vulnerable patient groups.

Main Methods:

  • A retrospective study analyzing data from the Aquitaine neurocardiovascular registry (January 2019 - August 2020).
  • Involved 9218 patients (6436 stroke, 2782 STEMI) across six emergency medical services and associated facilities.
  • Multivariate linear mixed models were used to analyze care management times (e.g., first medical contact-to-procedure for STEMI, emergency unit admission-to-imaging for stroke) in relation to patient vulnerabilities (social deprivation, age, neurocardiovascular history) across pre-wave, per-wave, and post-wave periods.

Main Results:

  • Pre-existing inequalities in care management times were identified for vulnerable STEMI patients (elderly, socially disadvantaged).
  • No significant interaction was found between COVID-19 waves and care management times for either STEMI or stroke patients concerning age, neurocardiovascular history, or deprivation.
  • Care management times for stroke patients did not show significant associations with the studied vulnerabilities or the pandemic period.

Conclusions:

  • Pre-existing healthcare inequalities for vulnerable STEMI and stroke patients were not significantly altered during the first COVID-19 wave.
  • The implemented crisis measures did not negatively impact the established emergency care pathways for these critical patient groups.
  • The study highlights the resilience of structured emergency pathways despite pandemic-related disruptions.
Abstract

Keywords:
COVID-19Health EquityHealth Services AccessibilityHealth policyOrganisation of health servicesQuality in health care

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