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1.
J Stroke Cerebrovasc Dis ; 31(6): 106455, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1773566

ABSTRACT

BACKGROUND AND PURPOSE: Hospitalizations for acute ischemic stroke (AIS) and transient ischemic attack (TIA) decreased during the COVID-19 pandemic. We compared the quality of care and outcomes for patients with AIS/TIA before vs. during the COVID-19 pandemic across the United States Department of Veterans Affairs healthcare system. METHODS: This retrospective cohort study compared AIS/TIA care quality before (March-September 2019) vs. during (March-September 2020) the pandemic. Electronic health record data were used to identify patient characteristics, quality of care and outcomes. The without-fail rate was a composite measure summarizing whether an individual patient received all of the seven processes for which they were eligible. Mixed effects logistic regression modeling was used to assess differences between the two periods. RESULTS: A decrease in presentations occurred during the pandemic (N = 4360 vs. N = 5636 patients; p = 0.003) and was greater for patients with TIA (-30.4%) than for AIS (-18.7%). The without-fail rate improved during the pandemic (56.2 vs. before 50.1%). The use of high/moderate potency statins increased among AIS patients (OR 1.26 [1.06-1.48]) and remained unchanged among those with TIA (OR 1.04 [0.83,1.29]). Blood pressure measurement within 90-days of discharge was less frequent during the pandemic (57.8 vs. 89.2%, p < 0.001). Hypertension control decreased among patients with AIS (OR 0.73 [0.60-0.90]) and TIA (OR 0.72 [0.54-0.96]). The average systolic and diastolic blood pressure was 1.9/1.4 mmHg higher during the pandemic than before (p < 0.001). Compared to before, during the pandemic fewer AIS patients had a primary care visit (52.5% vs. 79.8%; p = 0.0001) or a neurology visit (27.9 vs. 41.1%; p = 0.085). Both 30- and 90-day unadjusted all-cause mortality rates were higher in 2020 (3.6% and 6.7%) vs. 2019 (2.9, 5.4%; p = 0.041 and p = 0.006); but these differences were not statistically significant after risk adjustment. CONCLUSIONS: Overall quality of care for patients with AIS/TIA did not decline during the COVID-19 pandemic.


Subject(s)
COVID-19 , Ischemic Attack, Transient , Ischemic Stroke , Stroke , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/epidemiology , Ischemic Stroke/therapy , Pandemics , Quality of Health Care , Retrospective Studies , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy , United States/epidemiology
4.
J Stroke Cerebrovasc Dis ; 30(8): 105919, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1253283

ABSTRACT

BACKGROUND: The characteristics and pathophysiological mechanisms involved in acute ischemic stroke in patients with COVID-19 infection have not been fully clarified. We prospectively studied the phenotypic and etiological features of acute stroke occurring in COVID-19 infection. PATIENTS & METHODS: Within nine months starting from April-2020, the presence of COVID-19 infection was determined by thoracic CT and SARS-CoV-2 PCR in all acute stroke cases managed in a single tertiary center. Consecutive and prospective data on vascular risk factors/comorbidities, in-hospital quality metrics, discharge outcomes, etiological subclassification and blood markers of thrombosis / inflammation were compared in 44 COVID-19 positive cases (37 acute ischemic stroke, 5 TIA, 2 intracerebral hematoma) and 509 COVID-19 negative patients (355 ischemic, 105 TIA, 44 hematoma and 5 stroke mimic). RESULTS: COVID-19 positive patients had more severe strokes, delayed hospital admission, longer hospital stay, higher mortality rates, but had similar vascular risk factors/comorbidities frequency, thrombolysis/thrombectomy utilization rates, metrics, and stroke etiological subtype. They had significantly higher CRP, fibrinogen, ferritin, leukocyte count and lower lymphocyte count. No difference was detected in aPTT, INR, D-dimer, platelet, hemoglobin, homocysteine levels and ANA, anti-dsDNA antibody and ENA panel positivity rates. Anti-phospholipid antibodies have been studied in 70% of COVID-19 positive and all cryptogenic patients, but were never found positive. Tests for coagulation factor levels and hereditary thrombophilia did not show major thrombophilia in any of the stroke patients with COVID-19. CONCLUSION: We documented that there is no significant difference in etiological spectrum in acute stroke patients with COVID-19 infection. In addition, cryptogenic stroke and antiphospholipid antibody positivity rates did not increase.


Subject(s)
COVID-19/complications , Hemorrhagic Stroke/etiology , Ischemic Attack, Transient/etiology , Ischemic Stroke/etiology , Aged , Aged, 80 and over , Biomarkers/blood , Blood Coagulation , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , Case-Control Studies , Female , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/therapy , Humans , Inflammation Mediators/blood , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/therapy , Male , Middle Aged , Prognosis , Prospective Studies , Risk Assessment , Risk Factors
6.
BMJ Open ; 10(10): e041514, 2020 10 23.
Article in English | MEDLINE | ID: covidwho-889900

ABSTRACT

OBJECTIVE: The COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region. SETTING AND DESIGN: All the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019. RESULTS: We had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%. CONCLUSIONS: This multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Ischemic Attack, Transient , Pneumonia, Viral/epidemiology , Referral and Consultation/statistics & numerical data , Ambulatory Care Facilities/statistics & numerical data , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Hospitalization , Humans , Incidence , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , London/epidemiology , Pandemics , Preventive Health Services/methods , Preventive Health Services/statistics & numerical data , Quality of Health Care , SARS-CoV-2
7.
J Stroke Cerebrovasc Dis ; 29(11): 105228, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-718900

ABSTRACT

BACKGROUND: This report aims to describe changes that centres providing transient ischaemic attack (TIA) pathway services have made to stay operational in response to the SARS-CoV-2 pandemic. METHODS: An international cross-sectional description of the adaptions of TIA pathways between 30th March and 6th May 2020. Experience was reported from 18 centres with rapid TIA pathways in seven countries (Australia, France, UK, Canada, USA, New Zealand, Italy, Canada) from three continents. RESULTS: All pathways remained active (n = 18). Sixteen (89%) had TIA clinics. Six of these clinics (38%) continued to provide in-person assessment while the majority (63%) used telehealth exclusively. Of these, three reported PPE use and three did not. Five centres with clinics (31%) had adopted a different vascular imaging strategy. CONCLUSION: The COVID pandemic has led TIA clinics around the world to adapt and move to the use of telemedicine for outpatient clinic review and modified investigation pathways. Despite the pandemic, all have remained operational.


Subject(s)
Coronavirus Infections/therapy , Critical Pathways/trends , Delivery of Health Care, Integrated/trends , Hospital Rapid Response Team/trends , Ischemic Attack, Transient/therapy , Pneumonia, Viral/therapy , Practice Patterns, Physicians'/trends , Telemedicine/trends , Australia , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Cross-Sectional Studies , Diagnostic Imaging/trends , Europe , Humans , Ischemic Attack, Transient/diagnosis , New Zealand , North America , Pandemics , Personal Protective Equipment/trends , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Time Factors
8.
J Stroke Cerebrovasc Dis ; 29(11): 105229, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-693286

ABSTRACT

BACKGROUND AND AIMS: Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors. METHODS: Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges. RESULTS: The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5th March) and the implementation of the Act-FAST campaign (6th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here. CONCLUSION: Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID-19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health outcomes.


Subject(s)
Coronavirus Infections/therapy , Delivery of Health Care, Integrated/trends , Environment , Ischemic Attack, Transient/therapy , Patient Acceptance of Health Care , Pneumonia, Viral/therapy , Stroke/therapy , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , England/epidemiology , Humans , Interrupted Time Series Analysis , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Pandemics , Patient Admission/trends , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Referral and Consultation/trends , Risk Factors , Stroke/diagnosis , Stroke/epidemiology , Time Factors
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