Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up.

Journal: Neurology
Published:
Abstract

Objective: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).

Methods: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

Results: There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations.

Conclusions: There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. This study is registered under NCT04934020.

Authors
Thanh Nguyen, Muhammad Qureshi, Piers Klein, Hiroshi Yamagami, Robert Mikulik, Anna Czlonkowska, Mohamad Abdalkader, Petra Sedova, Anvitha Sathya, Hannah Lo, Ossama Mansour, Husitha Vanguru, Emilie Lesaine, Georgios Tsivgoulis, Aaron Loochtan, Jelle Demeestere, Ken Uchino, Violiza Inoa, Nitin Goyal, Andreas Charidimou, James Siegler, Shadi Yaghi, Diana Aguiar De Sousa, Mahmoud Mohammaden, Diogo Haussen, Espen Kristoffersen, Virginia Lereis, Sergio Scollo, Bruce C Campbell, Alice Ma, James Thomas, Mark Parsons, Shaloo Singhal, Lee-anne Slater, Rodrigo Tomazini Martins, Chris Enzinger, Thomas Gattringer, Aminur Rahman, Thomas Bonnet, Noemie Ligot, Sylvie De Raedt, Robin Lemmens, Peter Vanacker, Fenne Vandervorst, Adriana Conforto, Raquel C Hidalgo, Luciana De Oliveira Neves, Rodrigo Martins, Daissy Mora Cuervo, Leticia Rebello, Igor Santiago, Isabelle Lameirinhas Da Silva, Teodora Sakelarova, Rosen Kalpachki, Filip Alexiev, Luciana Catanese, Elena Cora, Mayank Goyal, Michael Hill, Michael Kelly, Houman Khosravani, Pascale Lavoie, Lissa Peeling, Aleksandra Pikula, Rodrigo Rivera, Hui-sheng Chen, Yimin Chen, Xiaochuan Huo, Zhongrong Miao, Shuiquan Yang, Marina Bedekovic, Marina Bralic, Hrvoje Budincevic, Angel Corredor Quintero, Osvaldo Lara Sarabia, Martin Cabal, Dusan Tenora, Petr Fibrich, Roman Herzig, Helena Hlaváčová, Emanuela Hrabanovska, David Hlinovsky, Lubomir Jurak, Jana Kadlcikova, Igor Karpowicz, Lukas Klecka, Martin Kovar, David Lauer, Jiri Neumann, Hana Palouskova, Martin Reiser, Petra Rekova, Vladimir Rohan, Ondrej Skoda, Miroslav Škorňa, Lenka Sobotková, Martin Sramek, Lenka Zakova, Hanne Christensen, Nicolas Drenck, Helle Iversen, Thomas Truelsen, Troels Wienecke, Khalid Sobh, Pauli Ylikotila, Kemal Alpay, Daniel Strbian, Patricia Bernady, Philippe Casenave, Maria Dan, Jean-marc Faucheux, Jean-christophe Gentric, Elsa Magro, Candice Sabben, Peggy Reiner, Francois Rouanet, Ferdinand Bohmann, Stefan Boskamp, Joshua Mbroh, Simon Nagel, Christian Nolte, Peter Ringleb, Michael Rosenkranz, Sven Poli, Götz Thomalla, Theodoros Karapanayiotides, Ioanna Koutroulou, Odysseas Kargiotis, Lina Palaiodimou, Jose Barrientos Guerra, Vikram Huded, Bindu Menon, Shashank Nagendra, Chintan Prajapati, P Sylaja, Nyoman Krishna Pramana, Achmad Sani, Abdoreza Ghoreishi, Mehdi Farhoudi, Elyar Hokmabadi, Tariq Raya, Shani Kalmanovich, Levite Ronen, Sergiu Sabetay, Maurizio Acampa, Alessandro Adami, Lucio Castellan, Marco Longoni, Raffaele Ornello, Leonardo Renieri, Claudia Bigliani, Michele Romoli, Simona Sacco, Andrea Salmaggi, Davide Sangalli, Andrea Zini, Ryosuke Doijiri, Hiroki Fukuda, Toshiyuki Fujinaka, Kyohei Fujita, Hirotoshi Imamura, Nobuyuki Sakai, Takuya Kanamaru, Naoto Kimura, Ryuhei Kono, Kosuke Miyake, Manabu Sakaguchi, Kenichiro Sakai, Kazutaka Sonoda, Kenichi Todo, Fumio Miyashita, Naoki Tokuda, Yuji Matsumaru, Shoji Matsumoto, Nobuyuki Ohara, Seigo Shindo, Yohei Takenobu, Takeshi Yoshimoto, Kazunori Toyoda, Takeshi Uwatoko, Yoshiki Yagita, Takehiro Yamada, Nobuaki Yamamoto, Ryoo Yamamoto, Yukako Yazawa, Yuri Sugiura, Peter Waweru, Jang-hyun Baek, Si Lee, Kwon-duk Seo, Sung-il Sohn, Anita Arsovska, Yong Chan, Wan Wan Zaidi, Ainul Jaafar, Fernando Gongora Rivera, Manuel Martinez Marino, Adrian Infante Valenzuela, Stanislav Groppa, Pavel Leahu, Jonathan Coutinho, Leon Rinkel, Diederik W Dippel, Dianne H Van Dam Nolen, Annemarei Ranta, Teddy Wu, Tajudeen Adebayo, Abiodun Bello, Ernest Nwazor, Taofiki Sunmonu, Kolawole Wahab, Ole Ronning, Else Sandset, Amal Al Hashmi, Saima Ahmad, Umair Rashid, Liliana Rodriguez Kadota, Miguel Vences, Patrick Yalung, Jon Hao Dy, Maria Pineda Franks, Christian Co, Waldemar Brola, Aleksander Debiec, Malgorzata Dorobek, Michal Karlinski, Beata Labuz Roszak, Anetta Lasek Bal, Halina Sienkiewicz Jarosz, Jacek Staszewski, Piotr Sobolewski, Marcin Wiacek, Justyna Zielinska Turek, Andre Araujo, Mariana Rocha, Pedro Castro, Vitor Cruz, Paulo Ferreira, Patricia Ferreira, Ana Nunes, Luisa Fonseca, João Marto, Teresa Pinho E Melo, Miguel Rodrigues, M Silva, Adela Dimitriade, Cristian Falup Pecurariu, May Hamid, Narayanaswamy Venketasubramanian, Georgi Krastev, Miroslav Mako, Oscar Ayo Martin, Francisco Hernández Fernández, Jordi Blasco, Alejandro Rodríguez Vázquez, Antonio Cruz Culebras, Francisco Moniche, Joan Montaner, Soledad Perez Sanchez, María García Sánchez, Marta Guillán Rodríguez, Katarina Jood, Annika Nordanstig, Michael Mazya, Tiago T Moreira, Gianmarco Bernava, Morin Beyeler, Manuel Bolognese, Emmanuel Carrera, Tomas Dobrocky, Grzegorz Karwacki, Emanuela Keller, Chang Hsieh, Surawan Boonyakarnkul, Anchalee Churojana, Ozlem Aykac, Atilla Ozdemir, Arsida Bajrami, Songul Senadim, Syed Hussain, Seby John, Soma Banerjee, Joseph Kwan, Kailash Krishnan, Robert Lenthall, Ashok Matthews, Ken Wong, Liqun Zhang, Dorothea Altschul, Kaiz Asif, Zeelalem Bahiru, Kristine Below, José Biller, Sean Ruland, Saqib Chaudry, Michael Chen, Alex Chebl, Jackie Cibulka, Leon Cistrunk, Judith Clark, Marco Colasurdo, Alexandra Czap, Adam De Havenon, Salvatore D'amato, Sushrut Dharmadhikari, Kasey Grimmett, Adam Dmytriw, Mark Etherton, Chizoba Ezepue, Mudassir Farooqui, Steven Feske, Lauren Fink, Ulviyya Gasimova, Amy Guzik, Maryam Hakemi, Majesta Hovingh, Muhib Khan, Dinesh Jillela, Peter Kan, Rakesh Khatri, Ayaz Khawaja, Naim Khoury, Nicole Kiley, Benny Kim, Murali Kolikonda, Anna Kuhn, Stephanie Lara, Guillermo Linares, Italo Linfante, Timothy Lukovits, Sarah Lycan, Shailesh Male, Laith Maali, John Mancin, Hesham Masoud, Ghada Mohamed, Andre Monteiro, Fadi Nahab, Krishna Nalleballe, Santiago Ortega Gutierrez, Ajit Puri, Yazan Radaideh, Rahul Rahangdale, Ansaar Rai, Pankajavalli Ramakrishnan, Aravind Reddy, Diana Rojas Soto, Jose Romero, Natalia Rost, Aaron Rothstein, Setareh Omran, Sunil Sheth, Adnan Siddiqui, Amy Starosciak, Nicholas Tarlov, Robert Taylor, Michael Wang, Jared Wolfe, Ka-ho Wong, Huynh Le, Quy Nguyen, Thong Pham, Trung Nguyen, Hoang Phan, Mai Ton, Urs Fischer, Patrik Michel, Davide Strambo, Sheila Martins, Osama Zaidat, Raul Nogueira

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