ABSTRACT
Background and aims: The consequences of the COVID-19 pandemic on the management of stroke patients are causing concerns. The objective was to assess the impact of changes in use of care and health reorganizations implementation, spurred by the first wave of the COVID- 19 pandemic on acute stroke management time. Methods: The study was based on a cohort of stroke patients included between January 2019 and August 2020 in a French regional stroke observatory and an ad-hoc collection of hospital reorganizations. The associations between reorganizations, use of care, and emergency unit (EU) admission-to-imaging time were analyzed through multivariate linear regression mixed models. Interaction terms between the use of care variables and the period (pre, per, post-wave) were introduced. Results: A total of 6,436 stroke patients were included in 14 hospitals. Four main trends were observed during the per-wave period compared to the pre and post-wave periods: 1) more frequent calls to Emergency Dispatch Organization (EDO) (65.5% vs 61.5% and 64.1%, p=0.083), 2) longer median times from symptoms onset- to-call to EDO (139 minutes vs. 121 minutes and 125 minutes, p=0.232), 3) longer median times from EU admission-to-imaging time (91 minutes vs. 83 minutes and 88 minutes, p=0.332), 4) less intravenous thrombolysis (14.6% vs. 19.4% and 16.7%, p=0.011). No association was found between reorganizations and EU admission-to-imaging times. Conclusions: Hospitals have demonstrated their adaptation ability during the first wave of the COVID-19 by implementing reorganizations without altering stroke pathway structuration. (Figure Presented).
ABSTRACT
Background and aims: The consequences of the COVID-19 pandemic on the management of stroke patients are causing concerns, particularly for vulnerable individuals, more likely impacted by health protection measures and modification of care support. The objective was to study the effect of the first Covid wave on the place of clinical (person at risk of severe COVID) and social vulnerabilities as health inequality on acute stroke management. Methods: The study was based on a cohort of stroke patients included between January 2019 and August 2020 in a French regional stroke observatory. The associations between vulnerabilities (clinical: age over 65 years old, cardiovascular history;socio-economic: deprivation index) and emergency unit admission-to-imaging time were analyzed through three multivariate linear regression mixed models. Interaction terms with time period (pre, per, post-wave) were introduced. Results: A total of 6,436 stroke patients were included in 14 hospitals. The models showed no statistically significant association between emergency unit admission-to-imaging time and advanced age (p=0.068), cardiovascular history (p=0.444) or deprivation (p=0.295), without any interaction with the COVID period. During the per (expb=1.169, 95%CI [1.006-1.359]) and post-wave (expb=1.072, 95%CI [0.984-1.168]) periods, the age-deleterious effect on stroke management time tended to decrease compared to the pre-wave period (expb=0.993, 95%CI [0.849- 1.162]). Conclusions: The COVID-19 pandemic induced no deep changes on the management time for the most vulnerable populations. An improvement time tendency is even noted for the elderly during the pre and post-wave periods.
ABSTRACT
Background: Risk-stratified BCS, integrating personal, familial variables and a polygenic risk score (PRS) is a promising strategy that may improve current BCS outcomes. Real-time risk assessment and field implementation are some of the main challenges for such an approach. Methods: MyPeBS is an ongoing EU-funded international randomized trial running in 6 countries. Eligible women (wn) aged 40-70 are randomized 1:1 between continuing standard organized BCS as recommended in their participating country/region and switching to risk-stratified BCS, in which BCS schedule and modalities are adapted to the individual predicted 5-year risk of invasive BC (IBC). Primary endpoint is 4-year incidence of stage 2 and higher BC. Secondary endpoints include PROs. 5-year IBC risk is estimated using the Mammorisk® BCSC-derived or the Tyrer Cuzick risk score and the centrally-determined PRS313 obtained from a saliva sample and calibrated for national BC incidence and age. We aim to describe 1) the feasibility of real-time assessment of BC risk and 2) the characteristics and risk profiles of the participants. Results: As of Sept. 7, 2021, 16,550 wn had been randomized. 29% were aged <50 (median age 54 (range 40-70), 13% had a previous benign breast biopsy, 40% a mammographic breast density C or D, 19% a 1st degree family history of breast or ovarian cancer;72% had tertiary education. 36% were estimated at low risk (<1% risk of IBC at 5 years), 29% at average risk, and 35% at high (34%) or very high risk (1%) (>1.67% and >6% risk, respectively). Only 2.5% of DNA extractions were not usable for genotyping, due to DNA concentration or quality;and 98.8% of the eligible DNA samples were successfully genotyped. Median turnover time from saliva sampling to risk result available was 11 weeks despite the COVID pandemic (currently 7 weeks). Conclusions: Real-time BC risk assessment based on a large set of polymorphisms, family, screening and hormonal history, and breast density is feasible within organized screening programmes. Participants are so far representative of different categories with some over-representation of highly educated participants. Clinical trial identification: NCT03672331. Legal entity responsible for the study: Unicancer. Funding: European Commission and French National Cancer Institute. Disclosure: S. Delaloge: Financial Interests, Institutional, Advisory Board: AstraZeneca;Financial Interests, Institutional, Invited Speaker: Exact Sciences;Financial Interests, Institutional, Advisory Board: Novartis;Financial Interests, Institutional, Advisory Board: Pierre fabre;Financial Interests, Institutional, Advisory Board: Orion;Financial Interests, Institutional, Advisory Board: Sanofi;Financial Interests, Institutional, Advisory Board: Rappta;Financial Interests, Institutional, Advisory Board: Cellectis;Financial Interests, Institutional, Advisory Board: Isis/servier;Financial Interests, Institutional, Invited Speaker: Pfizer;Financial Interests, Institutional, Invited Speaker: Seagen;Financial Interests, Institutional, Invited Speaker: Lilly;Financial Interests, Institutional, Invited Speaker: AstraZeneca;Financial Interests, Institutional, Invited Speaker: MSD;Financial Interests, Institutional, Advisory Board, ad board: Besins Healthcare;Financial Interests, Institutional, Invited Speaker: Roche Genentech;Financial Interests, Institutional, Invited Speaker: BMS;Financial Interests, Institutional, Invited Speaker: Puma;Financial Interests, Institutional, Invited Speaker: AstraZeneca;Financial Interests, Institutional, Invited Speaker: Orion;Financial Interests, Institutional, Invited Speaker: Sanofi;Financial Interests, Institutional, Funding: GE;Financial Interests, Institutional, Invited Speaker: Pfizer;Financial Interests, Institutional, Invited Speaker, clinical research funding to my institution: Taiho;Non-Financial Interests, Invited Speaker, Société Française de Sénologie et Pathologie Mammaire: SFSPM. D. Keatley: Financial Interests, Personal, Advisory Board: Public Advisory Board of Heealth Data UK. E. Gauthier: Financial Interests, Personal, Stocks/Shares: Predilife;Financial Interests, Personal, Full or part-time Employment: Predilife. S. Michiels: Financial Interests, Personal, Advisory Role: IDDI;Financial Interests, Personal, Advisory Role: Amaris;Financial Interests, Personal, Advisory Role: Roche;Financial Interests, Personal, Advisory Role: Sensorion;Financial Interests, Personal, Advisory Role: Biophytis;Financial Interests, Personal, Advisory Role: Servier;Financial Interests, Personal, Advisory Role: Yuhan. All other authors have declared no conflicts of interest.