TY - JOUR
T1 - Changes in Stroke Hospital Care during the COVID-19 Pandemic
T2 - A Systematic Review and Meta-Analysis
AU - Katsanos, Aristeidis H.
AU - Palaiodimou, Lina
AU - Zand, Ramin
AU - Yaghi, Shadi
AU - Kamel, Hooman
AU - Navi, Babak B.
AU - Turc, Guillaume
AU - Benetou, Vassiliki
AU - Sharma, Vijay K.
AU - Mavridis, Dimitris
AU - Shahjouei, Shima
AU - Catanese, Luciana
AU - Shoamanesh, Ashkan
AU - Vadikolias, Konstantinos
AU - Tsioufis, Konstantinos
AU - Lagiou, Pagona
AU - Sfikakis, Petros P.
AU - Alexandrov, Andrei V.
AU - Tsiodras, Sotirios
AU - Tsivgoulis, Georgios
N1 - Funding Information:
Dr Katsanos reports that he serves as the principal investigator of the DETECT trial (Blood Pressure Management in Stroke Following Endovascular Treatment). Dr Catanese reports grants from Canadian Stroke Consortium SPARC (Stroke Pandemic Agile Response Competition) grant outside the submitted work. Dr Kamel reports serving as a principal investigator for the National Institutes of Health-funded ARCADIA trial (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke; National Institute of Neurological Disorders and Stroke U01NS095869) which receives in-kind study drug from the Bristol Myers Squibb-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics, serving as Deputy Editor for JAMA Neurology, serving as a steering committee member of Medtronic’s Stroke AF trial (Rate of Atrial Fibrillation Through 12 Months in Patients With Recent Ischemic Stroke of Presumed Known Origin; uncompensated), and serving on an end point adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim. The other authors report no conflicts.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background and Purpose: We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. Methods: Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. Results: We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, -1.19 [95% CI, -2.05 to -0.32]; I2=70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01-1.22]; I2=54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12-0.98]; I2=90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07-2.48]; I2=49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05-1.52]; I2=55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05-1.47]; I2=40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. Conclusions: The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.
AB - Background and Purpose: We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. Methods: Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. Results: We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, -1.19 [95% CI, -2.05 to -0.32]; I2=70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01-1.22]; I2=54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12-0.98]; I2=90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07-2.48]; I2=49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05-1.52]; I2=55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05-1.47]; I2=40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. Conclusions: The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.
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UR - http://www.scopus.com/inward/citedby.url?scp=85115683800&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.121.034601
DO - 10.1161/STROKEAHA.121.034601
M3 - Article
C2 - 34344166
AN - SCOPUS:85115683800
SN - 0039-2499
VL - 52
SP - 3651
EP - 3660
JO - Stroke
JF - Stroke
IS - 11
ER -