Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic

Abstract

IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged Ն80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged Ն80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged Ն80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554)discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or (continued)

Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

“…During the early stages of the global COVID-19 pandemic, the prevalence of hospitalization for acute ischemic stroke (AIS) decreased and, in some countries, AIS case fatality rose. [1][2][3][4][5][6][7][8][9] These findings are unusual given that the overwhelming majority of cases were SARS-CoV-2-negative patients and hospitals in most parts of the world were accessible for emergency stroke care without significant interruption of service. 1,[10][11][12] The most commonly suggested explanation is that fear of hospital-acquired COVID-19 caused AIS patients to delay or defer hospital presentation.…”

In-Hospital Mortality in Non-COVID-19-Related Diseases before and during the Pandemic: A Regional Retrospective Study

“…In this period, it is conceivable that patients were hospitalized only for severe illnesses. Furthermore, access to the hospital appeared delayed, compared with that in previous years [17].…”

“…In emergency departments (EDs), it was reported that the rate of admission for critical patients was inversely related to the rate of admission for non-critical patients [16]. A clear reduction in hospitalizations for heart diseases during the beginning of the COVID-19 pandemic was observed [17]; the reduced number of hospital admissions has resulted in an increase in out-of-hospital deaths and long-term complications [18]. In a French study, a numerical increase in the rate of in-hospital deaths during the lockdown was observed; the increase was less than that found in an Iranian set [19].…”

COVID‐19 did not result in increased hospitalization for stroke and transient ischemic attack: A nationwide study

“…A clinical database in the US, again driven mostly by academic centers, examined monthly discharges with the diagnosis of ischemic stroke and found decreasing numbers in March and April 2020. Numbers returned to pre‐pandemic levels by July 2020 [ 18 ]. In a multinational study involving 457 stroke centers from 70 countries, a decrease of 11.5% in the admission rate and a decrease of 13.2% in thrombolysis treatment were observed [ 19 ].…”