How Telemedicine Impacted Stroke Follow-Up Care During the COVID-19 Pandemic

Despite the successful implementation of telemedicine services, the majority of patients with stroke did not complete posthospital follow-up care during the COVID-19 pandemic, according to study findings published in Journal of Stroke Cerebrovascular Diseases.

Due to the high risk for recurrence of stroke during the first 6 months after an episode, follow-up outpatient care is important in the prevention of secondary stroke and reduction of morbidity and mortality.

In a retrospective cohort study, researchers studied the impact of telemedicine on postacute stroke clinic follow-up during the COVID-19 pandemic.

Study participants were adults enrolled in Emory Healthcare in Atlanta, Georgia, who had an ischemic stroke and were discharged home or to another health care facility between January 2019 and December 2020. The hospital has been certified as a comprehensive stroke center as well as has 2 primary stroke centers.

The primary study outcome was 90-day follow-up after discharge.

The study period was classified into 3 categories with regard to telemedicine services, including preimplementation (January 2019 to February 2020), implementation (March 2020 to April 2020), and postimplementation (May 2020 to December 2020).

Variables assessed included socioeconomic status; event-related variables, such as mode of transport and day of discharge; patients’ preexisting conditions; medical history; disease characteristics, such as etiology of stroke, and presentation signs; and type of treatment.

Overall, 1,096 patients (47% women; 47% non-White; median age, 70 years) with ischemic stroke were discharged from the hospital, among whom 31% received follow-up care at a stroke clinic within 90 days of admission.

The researchers found that patients who were discharged from the comprehensive stroke center vs the primary stroke centers were more likely to receive follow-up care (P <.001). Attendance to follow-up care increased from 19% to 41% after the implementation of telemedicine services (P <.001); follow-up telemedicine appointments also increased from 11% to 28% (P <.001).

Multivariate analysis indicated that patients with stroke who were discharged in the postimplementation period received follow-up care more often that those who were discharged in the preimplementation period (odds ratio, 2.11; 95% CI, 1.46-3.03).

In addition, follow-up care was more common among patients who were women, had private insurance, had a history of dyslipidemia or stroke, received thrombolysis, and were receiving ambulatory care at discharge. Patients who did not have insurance, required transportation, had a history of diabetes, and those discharged to a nonacute care facility were less likely to receive posthospital follow-up.

Study limitations included the inconsistency in timing of the implementation of telemedicine services and the fear of COVID-19 infection among patients, which may have had an impact on receiving follow-up care at any health care facility.

The researchers concluded, “Further study is warranted to see if reducing barriers can continue to increase stroke follow up.”