Delaysin thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration

ABSTRACT

Objective: To investigate whether delays in intravenous thrombolysis (IVT) administration during the Coronavirus (COVID-19) pandemic for patients with suspected acute ischemic stroke are associated with worse neurologic outcomes. Background: The COVID-19 pandemic has had a deleterious impact on health care systems across the world. Delays in presentation and management of emergent medical conditions like myocardial infarction, and stroke have been reported with a recent multicenter cohort study demonstrating that the COVID-19 pandemic has led to delays in IVT administration. It is unknown if these delays contribute to meaningful differences in short-term outcomes. Design/Methods: This was a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers in 7 states across the United States. Patients admitted prior to the pandemic (1/1/2019-2/19/2020) were compared to those admitted during the early pandemic (3/1/2020-7/31/2020). The effect of delay in IVT administration on death and discharge destination was estimated using multivariable logistic regression model. Results: There were 676 patients who received IVT with a median age of 70 (IQR 58-81) years and median NIHSS of 8 (IQR 4-16). 313 patients (46.3%) were female. During the early COVID19 period, longer treatment delays were observed (median 46 versus 38 minutes, p=0.01) that were associated with higher in-hospital death or hospice discharge (OR per hour 1.08, 95% CI 1.01-1.17, p = 0.03). After multivariable adjustment, this effect was strengthened (aOR 1.15, 95% CI 1.07-1.24, p < 0.001). Each hour delay in IVT administration was also associated with 7% lower odds of being discharged home or to a rehabilitation facility (aOR 0.93, 95% CI 0.89-0.97, p < 0.001). Conclusions: Treatment delays observed during the COVID-19 pandemic led to worse shortterm outcomes with higher rates of mortality and hospice care along with lower rates of discharge to home or rehabilitation facility.