How COVID-19 Affected Stroke Hospitalization Trends During the First Year

Stroke hospitalization decreased during the first year of the COVID-19 pandemic comapred with the previous year, according to study findings published in Neurology.

Stroke is an important complication of COVID-19 and is estimated to affect 1.1%-1.5% of patients hospitalized with SARS-CoV-2 infections. Despite the prevalence of stroke, an initial report found a >10% decrease in global stroke admissions and intravenous thrombolysis (IVT) treatments and transfers during the first 4 months of the pandemic.

Researchers assessed the change in stroke care volume during the first year of the pandemic. They sourced data from 457 stroke centers in 70 countries by communication with stroke leaders of national and international stroke societies. For the cross-sectional, observational, retrospective study, Global Impact of the COVID 19 Pandemic on Stroke Care, Cerebral Venous Thrombosis, and Subarachnoid Hemorrhage, (ClinicalTrials.gov Identifier: NCT04934020), researchers evaluated aggregate volumes of stroke-related diagnoses and therapies during the pandemic period (March 2020-February 2021) and compared them with the previous year (March 2019-February 2020).

Overall, ischemic stroke admissions decreased during the first year of the pandemic by -7.0% (95% CI, -7.1% to -6.9%; P <.0001), in which mean admissions decreased from 43.8 per month prepandemic to 40.3 per month during the pandemic (P <.0001).

The rate of intracerebral hemorrhage admissions decreased by -4.8% (95% CI, -5.1 to -4.6%; P <.0001) overall, or from an average of 9.7 per month prepandemic to 9.2 during the pandemic.

The volume of IVT decreased by -6.1% (95% CI, -6.4% to -5.8%; P <.0001) during the pandemic, from 7.5 mean monthly admissions prepandemic to 7.0 during the pandemic.

In general, rates of decline were consistent at centers when stratifying by hospital stroke volume, hospital COVID-19 volume, and primary or comprehensive stroke care status. The exceptions were that intracerebral hemorrhage admissions (change, 14.6%; 95% CI, 13.2-16.1; P <.0001) and IVT (change, 7.1%; 95% CI, 6.8%-8.2%; P =.021) increased from prepandemic levels at low-volume centers. In addition, intracerebral hemorrhage admissions and IVT remained statistically similar at low COVID-19 volume hospitals (both, P ≥.272), intracerebral hemorrhage admissions remained similar at primary stroke centers (P =.150) and IVT remained similar at intermediate stroke volume centers (P =.072).

For mechanical thrombectomy rates, no significant change from prepandemic levels was observed during the pandemic (change, 0.7%; 95% CI, 0.6%-0.9%; P =.492). Stratified by hospital features, a significant increase was observed at low- (change, 13.6%; 95% CI, 11.9%-15.4%; P =.001) and intermediate- (change, 3.9%; 95% CI, 3.4%-4.5%; P =.047) volume centers.

Among patients hospitalized with COVID-19, 1.34% were diagnosed with stroke. The rate of concomitant COVID-19 and stroke diagnoses was highest in Asia (1.63%), followed by Europe (1.61%), North America (1.11%), Africa (0.84%), South America (0.82%), and Oceania (0.0%).

This study was limited by not being able to track trends at the patient level.

These data indicated that stroke, intracranial hemorrhage admissions, and IVT volumes decreased worldwide during the first year of the COVID-19 pandemic. In general, there were a shift for patients to present at lower-volume centers. Mechanical thrombectomy volumes did not appear to be affected during the first year of the pandemic.

The researchers concluded that “Taken with recent studies suggesting that SARS-CoV-2 is likely to become endemic across the globe, this raises concern that SARS-CoV-2 may become an addition to other respiratory infections (influenza, mycoplasma pneumonia) known to trigger and present as a risk factor for stroke.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.