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Effects of healthcare system transformations spurred by the COVID-19 pandemic on management of stroke and STEMI: a registry-based cohort study in France.
Lesaine, Emilie; Francis-Oliviero, Florence; Domecq, Sandrine; Bijon, Marine; Cetran, Laura; Coste, Pierre; Lhuaire, Quentin; Miganeh-Hadi, Sahal; Pradeau, Catherine; Rouanet, François; Sevin, Floriane; Sibon, Igor; Saillour-Glenisson, Florence.
  • Lesaine E; CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France emilie.lesaine@u-bordeaux.fr.
  • Francis-Oliviero F; University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.
  • Domecq S; University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.
  • Bijon M; Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France.
  • Cetran L; CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France.
  • Coste P; University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.
  • Lhuaire Q; Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France.
  • Miganeh-Hadi S; Coronary Care Unit, CHU de Bordeaux Hôpital Cardiologique, Pessac, France.
  • Pradeau C; Coronary Care Unit, CHU de Bordeaux Hôpital Cardiologique, Pessac, France.
  • Rouanet F; University of Bordeaux, Talence, France.
  • Sevin F; Pôle de santé publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France.
  • Sibon I; CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France.
  • Saillour-Glenisson F; University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.
BMJ Open ; 12(9): e061025, 2022 09 21.
Article in English | MEDLINE | ID: covidwho-2038306
ABSTRACT

OBJECTIVE:

To assess the impact of changes in use of care and implementation of hospital reorganisations spurred by the COVID-19 pandemic (first wave) on the acute management times of patients who had a stroke and ST-segment elevation myocardial infarction (STEMI).

DESIGN:

Two cohorts of patients who had an STEMI and stroke in the Aquitaine Cardio-Neuro-Vascular (CNV) registry.

SETTING:

6 emergency medical services, 30 emergency units (EUs), 14 hospitalisation units and 11 cathlabs in the Aquitaine region.

PARTICIPANTS:

This study involved 9218 patients (6436 patients who had a stroke and 2782 patients who had an STEMI) in the CNV Registry from January 2019 to August 2020.

METHOD:

Hospital reorganisations, retrieved in a scoping review, were collected from heads of hospital departments. Other data were from the CNV Registry. Associations between reorganisations, use of care and care management times were analysed using multivariate linear regression mixed models. Interaction terms between use-of-care variables and period (pre-wave, per-wave and post-wave) were introduced. MAIN OUTCOME

MEASURES:

STEMI cohort, first medical contact-to-procedure time; stroke cohort, EU admission-to-imaging time.

RESULTS:

Per-wave period management times deteriorated for stroke but were maintained for STEMI. Per-wave changes in use of care did not affect STEMI management. No association was found between reorganisations and stroke management times. In the STEMI cohort, the implementation of systematic testing at admission was associated with a 41% increase in care management time (exp=1.409, 95% CI 1.075 to 1.848, p=0.013). Implementation of plan blanc, which concentrated resources in emergency activities, was associated with a 19% decrease in management time (exp=0.801, 95% CI 0.639 to 1.023, p=0.077).

CONCLUSIONS:

The pandemic did not markedly alter the functioning of the emergency network. Although stroke patient management deteriorated, the resilience of the STEMI pathway was linked to its stronger structuring. Transversal reorganisations, aiming at concentrating resources on emergency care, contributed to maintenance of the quality of care. TRIAL REGISTRATION NUMBER NCT04979208.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Stroke / Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2022-061025

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Stroke / Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2022-061025