Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Abstract

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]; I 2 =70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01–1.22]; I 2 =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]; I 2 =90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07–2.48]; I 2 =49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05–1.52]; I 2 =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]; I 2 =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.

Fewer COVID‐19‐associated strokes and reduced severity during the second COVID‐19 wave: The Madrid Stroke Network

“…This was a multicenter cohort study aimed at describing the differences in clinical characteristics and outcomes of patients with acute The COVID-19 pandemic changed the clinical profile of patients with acute stroke, with an increased prevalence of younger patients and more severe strokes attributed to large vessel occlusions and higher in-hospital mortality compared with pre-COVID controls [20]. Our study shows no changes in the demographic and risk factor profile between the first two waves, but lower stroke severity and in-hospital mortality in the second wave.…”

Therapeutic Trends of Cerebrovascular Disease during the COVID-19 Pandemic and Future Perspectives

“…While there have been declines in absolute numbers of patients treated with reperfusion therapies for acute ischemic stroke, the relative proportion of patients treated with EVT has risen. A recent meta-analysis of 46 observational cohort studies (including 129,491 patients) reported a 24% increase in the odds of EVT during pandemic months when compared to a prior control period [ 48 ]. This is likely, at least in part, explained by the higher proportion of patients having more severe strokes at presentation [ 7 ], with a 63% higher odds of having a large vessel occlusion [ 48 ].…”

Acute telestroke evaluations during the COVID-19 pandemic

“…Younger age may be a reflection of those without recognized, or yet diagnosed, traditional vascular risk factors for AIS having neurological symptoms and complications (such as AIS) from COVID-19; however, positivity status and medical history are not collected in this database. A recent systematic review and meta-analysis revealed increased proportions of younger patients and severe strokes attributed to a LVO but also noted that higher rates of undiagnosed and thus untreated atrial fibrillation following regional lockdowns were seen and could be an explanation for younger age [ 18 ]. This apprehension to go outside and possibly contracting COVID-19 could also skew the population as older patients with more risk factors may have stayed home and not sought emergent care despite stroke symptoms.…”