Stroke care during the pandemic's first wave included younger patients, lower survival rates
Stroke patients admitted during the ongoing COVID-19 pandemic tended to be younger than patients admitted before the pandemic began, according to a new meta-analysis published in Stroke. The study's authors also found that the in-hospital mortality rate was consistently higher.
"Researchers and clinicians have expressed concerns regarding the negative impact of COVID-19 outbreaks on the ability of health care systems to provide timely assessment and acute therapies to patients with stroke," wrote first author Aristeidis H. Katsanos, MD, with the division of neurology at McMaster University in Canada, and colleagues. "COVID-19 imposed restrictions, and the ensuing suboptimal care delivery, could thus indirectly cause increased stroke-related mortality and disability. Moreover, accruing data are indicating that COVID-19 may be associated with an increased risk of ischemic stroke and cryptogenic stroke in particular."
To dive deeper into this question, the authors performed a full meta-analysis of 46 different studies, focusing on data from nearly 130,000 patients who received care during the early months of the pandemic. Patient demographics, risk factors and outcomes were then compared with patients treated at the same facilities before COVID-19.
Overall, Katsanos et al. found that patients admitted during the pandemic were younger, more likely to present with with a severe stroke attributed to a large vessel occlusion (LVO) and more likely to require endovascular thrombectomy (EVT) treatment. In addition, in-hospital mortality increased during this period.
"COVID-19 infection has been suggested to trigger endothelial damage and immune-related hypercoagulability, which ultimately can lead to thromboembolic phenomena and increased prevalence of intracranial occlusions in the brain circulation of young patients presenting with stroke symptoms," the authors wote. "Additionally, it is postulated that the higher prevalence of LVO and more severe stroke syndromes during the COVID-19 pandemic could be related to higher rates of undiagnosed and thus untreated atrial fibrillation following regional lockdowns, as highlighted by a recent Danish registry."
The higher rates of EVT treatment, the team added, may be directly related to the rise in LVO rates.
Certain aspects of patient care did remain the same after the start of the pandemic.
“No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected," the authors wrote.
Overall, the team concluded, the meta-analysis provided key context—but still left many questions that still need to be answered.
“These observations require further confirmation by uninterrupted observation of the evolution of stroke epidemiology and care delivery over the total span and phases of the COVID-19 pandemic within the settings of appropriately designed prospective cohort studies,” the authors wrote.
Read the full meta-analyses here.