Global Impact of Covid-19 on Stroke Care and Iv Thrombolysis
Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.
Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.
Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.
Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
Nogueira, R. G., Qureshi, M. M., Abdalkader, M., Martins, S. O., Yamagami, H., Qiu, Z., Mansour, O. Y., Sathya, A., Czlonkowska, A., Tsivgoulis, G., Aguiar de Sousa, D., Demeestere, J., Mikulik, R., Vanacker, P., Siegler, J. E., Kõrv, J., Biller, J., Liang, C. W., Sangha, N. S., Zha, A. M., … SVIN COVID-19 Global Stroke Registry (2021). Global Impact of COVID-19 on Stroke Care and IV Thrombolysis. Neurology, 96(23), e2824–e2838. https://doi.org/10.1212/WNL.0000000000011885