During the first weeks of lockdown amid the 2020 COVID-19 pandemic, admission rates of ischemic stroke and transient ischemic attack (TIA) were significantly lower compared with rates reported in the preceding years; contrastingly, there were no significant differences in the admission rates for hemorrhagic stroke or mortality, according to study results reported in Circulation.
The researchers conducted a nationwide cohort study to explore stroke and TIA admission rates and prognosis in Denmark during the COVID-19 pandemic. Data on all Danish citizens in a combined period between January 2 and May 8, 2017-2019 were compared with data between January 2 and May 7, 2020. Incidence rates of first-time stroke/TIA admissions and mortality before and after March 13 were compared in both periods.
Before March 13, 2862 patients, on average, were admitted with stroke or TIA in 2017-2019, compared with a total of 2954 patients in 2020. After March 13, an average of 2323 patients were admitted for these reasons in 2017-2019, compared with 2029 patients in 2020.
During the first weeks of lockdown in 2020, the admission rates of stroke or TIA were significantly lower compared with those reported in 2017-2019. Study researchers, however, observed differences according to stroke subtypes. While the admission rate for hemorrhagic stroke was similar in 2020 compared to 2017-2019, those for ischemic stroke and TIA were significantly lower during the first weeks of lockdown in 2020. Towards the end of the study period, admission rates for the latter two subtypes returned to ones similar to those observed in 2017-2019.
Mortality rates for patients admitted with stroke or TIA were not significantly different before or after March 13 2020 compared with 2017-2019. This finding applied both to overall mortality and that according to stroke subtypes.
The study had several limitations, including the exclusion of out-of-hospital deaths, low number of deaths, limited follow-up, and missing data on stroke severity. Such limitations prevented long-term assessment of the pandemic’s impact on stroke care.
“These data do not indicate that patients present with more severe strokes or that reorganization of healthcare systems, which may have influenced in-hospital treatment delay, including effective triage and rapid identification of treatment options, have had an impact on very short-term mortality,” concluded the researchers.
Butt JH, Fosbøl EL, Østergaard L, et al. The Impact of Coronavirus Disease 2019 (COVID-19) on first-time acute stroke and transient ischemic attack admission rates and prognosis in Denmark: A nationwide cohort study. Circulation. Published online, August 5, 2020. doi:10.1161/CIRCULATIONAHA.120.050173