Your browser doesn't support javascript.
Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results.
Ghoreishi, Abdoreza; Arsang-Jang, Shahram; Sabaa-Ayoun, Ziad; Yassi, Nawaf; Sylaja, P N; Akbari, Yama; Divani, Afshin A; Biller, Jose; Phan, Thanh; Steinwender, Sandy; Silver, Brian; Zand, Ramin; Basri, Hamidon Bin; Iqbal, Omer M; Ranta, Annemarei; Ruland, Sean; Macri, Elizabeth; Ma, Henry; Nguyen, Thanh N; Abootalebi, Shahram; Gupta, Animesh; Alet, Matias; Lattanzi, Simona; Desai, Masoom; Gagliardi, Rubens J; Girotra, Tarun; Inoue, Manabu; Yoshimoto, Takeshi; Isaac, Cristian Flavo; Mayer, Stephan A; Morovatdar, Negar; Nilanont, Yongchai; Nobleza, Christa O'Hana S; Saber, Hamidreza; Kamenova, Saltanat; Kondybayeva, Aida; Krupinski, Jerzy; Siegler, James E; Stranges, Saverio; Torbey, Michel T; Yorio, Diana; Zurrú, María Cristina; Rubinos, Clio Aracelli; Shahripour, Reza Bavarsad; Borhani-Haghighi, Afshin; Napoli, Mario Di; Azarpazhooh, M Reza.
  • Ghoreishi A; Stroke Research Group, Department of Neurology and Stroke Unit, Vali-e-Asr hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
  • Arsang-Jang S; Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
  • Sabaa-Ayoun Z; Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
  • Yassi N; Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
  • Sylaja PN; Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
  • Akbari Y; Departments of Neurology, Neurological Surgery, and Anatomy & Neurobiology, Beckman Laser Institute & Medical Clinic, University of California, Irvine, CA, USA.
  • Divani AA; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
  • Biller J; Department of Neurology, Loyola University, Stritch School of Medicine, Chicago, IL, USA.
  • Phan T; Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences, Monash University, Australia.
  • Steinwender S; Health Information Science, Western University, London, Ontario, Canada; Regional Stroke Prevention, Southwestern Ontario Stroke Network, London Health Sciences, London, Ontario, Canada.
  • Silver B; Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
  • Zand R; Department of Neurology, Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA.
  • Basri HB; Department of Medicine, Faculty of Medicine and Health Sciences, UPM, Serdang, Malaysia.
  • Iqbal OM; Department of Pathology and Ophthalmology, Center for Translational Research & Education, Loyola University Stritch School of Medicine, Maywood, IL, USA.
  • Ranta A; Department of Medicine and Neurology, University of Otago and Wellington Hospital, Wellington, New Zealand.
  • Ruland S; Department of Neurology, Loyola University, Stritch School of Medicine, Chicago, IL, USA.
  • Macri E; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
  • Ma H; Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences, Monash University, Australia.
  • Nguyen TN; Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
  • Abootalebi S; Dr. Everett Chalmers Regional Hospital, Dalhousie University, New Brunswick, Canada.
  • Gupta A; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
  • Alet M; Vascular Neurology Division, Department of Neurology, Fleni, Buenos Aires, Argentina.
  • Lattanzi S; Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy.
  • Desai M; Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
  • Gagliardi RJ; Neurology Department, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil.
  • Girotra T; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
  • Inoue M; Department of Cerebrovascular Medicine/Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
  • Yoshimoto T; Department of Cerebrovascular Medicine/Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
  • Isaac CF; Hospital Dr. Arturo Oñativia, Rafael Calzada, Alte Brown, Pcia de Bs As, Argentina.
  • Mayer SA; Westchester Medical Center Health Network, Director of Neurocritical Care and Emergency Neurological Services, Valhalla, NY, USA; Westchester Medical Center Health Network, New York Medical College, Valhalla, NY, USA.
  • Morovatdar N; Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Nilanont Y; Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
  • Nobleza COS; Departments of Neurology and Neurosurgery, Division of Neuroscience Critical Care, University of Mississippi Medical Center, Jackson, MS, USA.
  • Saber H; Wayne State University, Detroit, MI, USA.
  • Kamenova S; Department of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan.
  • Kondybayeva A; Department of Neurology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
  • Krupinski J; Department of Neurology, Hospital Universitari MutuaTerrassa, Terrassa, Barcelona, Spain; Department of Life Sciences, CBS, Manchester Metropolitan University, Manchester, UK.
  • Siegler JE; Department of Neurology, Cooper University Hospital, Camden, NJ, USA.
  • Stranges S; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Population Health, Luxembourg Ins
  • Torbey MT; Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
  • Yorio D; Department of Neurology, British Hospital, Montevideo, Uruguay.
  • Zurrú MC; Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Rubinos CA; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  • Shahripour RB; UCSD Stroke center, Department of Neurosciences, University of California, San Diego, USA.
  • Borhani-Haghighi A; Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  • Napoli MD; Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
  • Azarpazhooh MR; Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Clinical Neurological Sc
J Stroke Cerebrovasc Dis ; 29(12): 105321, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-872317
Semantic information from SemMedBD (by NLM)
1. Cerebrovascular accident COEXISTS_WITH COVID-19
Subject
Cerebrovascular accident
Predicate
COEXISTS_WITH
Object
COVID-19
2. COVID-19 AFFECTS Cerebrovascular accident
Subject
COVID-19
Predicate
AFFECTS
Object
Cerebrovascular accident
3. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
4. COVID-19 AFFECTS Childbirth
Subject
COVID-19
Predicate
AFFECTS
Object
Childbirth
5. Cerebrovascular accident COEXISTS_WITH COVID-19
Subject
Cerebrovascular accident
Predicate
COEXISTS_WITH
Object
COVID-19
6. COVID-19 AFFECTS Cerebrovascular accident
Subject
COVID-19
Predicate
AFFECTS
Object
Cerebrovascular accident
7. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
8. COVID-19 AFFECTS Childbirth
Subject
COVID-19
Predicate
AFFECTS
Object
Childbirth
ABSTRACT

BACKGROUND:

The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.

METHODS:

This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.

RESULTS:

During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta -1.034; Standard Error (SE) 0.22, 95% CrI -1.48, -0.59] and ITS analysis (estimate -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001).

CONCLUSION:

In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Outcome and Process Assessment, Health Care / Thrombolytic Therapy / Brain Ischemia / Stroke / Intracranial Hemorrhages / Time-to-Treatment / COVID-19 / Hospitalization Type of study: Controlled clinical trial / Diagnostic study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2020 Document Type: Article Affiliation country: J.jstrokecerebrovasdis.2020.105321

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Outcome and Process Assessment, Health Care / Thrombolytic Therapy / Brain Ischemia / Stroke / Intracranial Hemorrhages / Time-to-Treatment / COVID-19 / Hospitalization Type of study: Controlled clinical trial / Diagnostic study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2020 Document Type: Article Affiliation country: J.jstrokecerebrovasdis.2020.105321