IMPACT OF COVID-19 ON ACUTE STROKE CARE IN A LARGE CENTER FROM A MIDDLE- INCOME COUNTRY

ABSTRACT

Objective: The COVID-19 pandemic had impact on stroke care around the world, but middle and lowincome countries may have struggled more to cope with the spread of the virus because of its more fragile health care systems. We aimed to measure this impact on ischemic stroke acute care in the largest medical center from Latin America. Methods: We conducted an observational study from a prospective database and compared key performance indicators related to acute stroke care from ischemic stroke admissions over 1 year after the pandemic (March 16, 2020 to March 15, 2021) to 1 year before (March 16, 2019 to March 15, 2020). Results: We analyzed 1.228 ischemic stroke admissions and both groups were similar regarding to age (p = 0.4), sex (p = 0.4) and NIHSS (p = 0.1). There were 657 admissions, 139 intravenous thrombolysis (IVT) and 31 mechanical thrombectomies (MT) before the pandemic versus 571 admissions, 97 IVT and 19 MT after, representing a non-statistically significant decline from 21% to 16% of IVT (p = 0.06) and from 4% to 3% decline in MT (p = 0.2). After the pandemic, there was an increase in door-toimaging time compared to the previous year (50 x 27 minutes, p < 0.001), but there was no difference regarding to door-to-needle time for IVT (p = 0.1) or door-to-puncture for MT (p = 0.7). Conclusions: In the largest medical center from Latin America, the COVID-19 pandemic was associated with an increase in door-to-imaging time, but there was no difference regarding to IVT/MT rates or to reperfusion time indicators (door-to-needle and door-to-puncture time).