ABSTRACT
Introduction: Telemedicine is increasingly used, but its effectiveness for stroke prevention after minor stroke or TIA is not known. We compared the care and outcomes in patients discharged from an emergency department (ED) with TIA or stroke before and after the implementation of telemedicine stroke prevention clinics in Ontario, Canada. We hypothesized that care and outcomes will remain similar. Methods: We used linked administrative data to identify community-dwelling adults discharged from the ED with TIA or ischemic stroke from April 2015 to March 2020 (pre-telemedicine) and April 2020 to March 2021 (post-telemedicine). We compared access to outpatient physician visits within 90 days, neuroimaging or vascular imaging within 14 days, and echocardiogram within 90 days using standardized differences (SD <0.1 indicates negligeable difference). We used Cox proportional hazard models to compare the adjusted Hazard Ratio (aHR) and 95% confidence intervals of death within 90 days pre- and post-telemedicine and cause-specific hazard models for stroke readmission with adjustment for comorbidities. Results: We identified 47,869 patients (n=40,099 pre- and n=7,770 post-telemedicine), median age 73 years [62, 82], 49% female. Baseline characteristics were similar. There was a rapid uptake in telemedicine use (Figure 1). Physician visits (92.9% vs 93.1%, SD 0.01), neuroimaging (81.3% vs 80.5%, SD 0.02), and echocardiogram use (52.5% vs 53.9% SD 0.03) were similar, but use of vascular imaging increased (74.8% vs 84.3% SD 0.24). Readmission for stroke was stable (3.9% vs 4.0%, aHR 1.00 [0.89, 1.13]), but 90-day death was higher post- compared to pre-telemedicine (2.8% vs 3.6%, aHR 1.19 [1.05, 1.36]). Conclusion: Telemedicine is a promising tool to support routine stroke prevention care. The higher mortality must be interpreted in the context of the COVID19 pandemic. Ongoing monitoring of stroke outcomes is needed. (Figure Presented).
ABSTRACT
Introduction: Reductions in hospital visits for stroke during the COVID19 pandemic have been reported, but few have studied this question on a population-basis and less is understood about the temporal trends after economic and social reopening. We aimed to describe the rate of emergency department visits for acute stroke before and after the declaration of the pandemic, through the different phases of reopening, in the population of Ontario, Canada (14 million people). Methods: Using administrative data linkage, we will show the age- and sex-standardized rate of weekly emergency department visits for ischemic or hemorrhagic stroke between January 1 to September 30, 2020. Pandemic declaration was on March 11, 2020 (week 11) and phase 1 reopening started on May 19, 2020 (week 20) in Ontario. We will use piecewise regression analysis models to evaluate the changes in rates during the pandemic and after reopening. Results: We identified 5,617 emergency department visits for stroke (53% male, median age 74 IQR [63,83]) between January 1 to May 19, 2020 (week 20). Data beyond May 19, 2020 are not available yet, but these will be presented at the ISC 2021. The proportion of patients treated at a comprehensive stroke center was similar pre- and post-pandemic (41.7% versus 42.7%, standard difference (SD) 0.02), as was the proportion of people admitted to hospital (87.9% versus 86.7%, SD 0.03), treated with intravenous thrombolysis (11.6% versus 11.8%, SD 0.01), or underwent endovascular thrombectomy (5.1% versus 4.8%, SD 0.02). Weekly rates of stroke visits decreased after the pandemic declaration, but they seem to increase after week 16 (Figure 1). We show rates from 2019 for comparison. Conclusions: Population-based rates of emergency department visits for stroke initially decreased after the pandemic compared to pre-pandemic rates. Changes in rates after reopening and the results of the piecewise regression analysis will be presented at the ISC 2021.(Figure Presented).