Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Abstract

Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 ( P =0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

Stroke Care Within the COVID-19 Pandemic—Increasing Awareness of Transient and Mild Stroke Symptoms Needed

“…We observed a decrease by nearly one quarter in the number of patients admitted to our primary stroke center with stroke or TIA from a mean-rate of 95.9 (±6.3) per month between January 2019 and February 2020 to 74 (±12.7) in March/April 2020. Our observation is in line with numerous reports of decreased stroke rates during the pandemic from North America ( 4 , 9 , 10 ), Canada ( 5 ), and Brazil ( 6 ). In addition, a decrease in the usage of the RAPID-software, a tool used to assess infarct volume in case of acute stroke symptoms, was observed by mid-March 2020 ( 11 ) and telestroke services were less frequently used ( 9 ).…”

“…Our hypothesis is strengthened by the fact that we observed unchanged rates of hemorrhagic stroke during the pandemic, which are usually accompanied by a more severe disability compared to ischemic strokes. This is further underlined by a retrospective analysis from Brazil also demonstrating unchanged rates of hemorrhagic stroke during the pandemic compared to pre-pandemic numbers and reporting an unchanged rate of severe strokes ( 6 ). In line with this, a multicenter analysis from Northern California reports decreased stroke rates in the early pandemic and even more severe strokes and large vessel occlusions ( 4 ).…”

“…Moreover, the organizational structure of hospitals changed in order to be prepared for an increased admission of COVID-19 patients by reducing non-emergency ambulatory patients and elective hospital admissions. These circumstances led to the question of what happens with other severe disease such as stroke, especially considering reports from Italian colleagues depicting almost a disappearance of patients with ischemic strokes within their hospitals ( 3 ) and similar reports from North America ( 4 , 5 ) and Brazil ( 6 ). We aim to elucidate whether the COVID-19 pandemic affected either the admission of patients to our primary care stroke center or the rates of stroke recanalization therapies.…”

Stroke Systems of Care During the COVID-19 Epidemic in Kobe City

“…In fact, a report from Brazil has suggested that the COVID-19 outbreak coincided with a reduction in transient, mild, and moderate strokes. 8 There were no cases of symptomatic stroke among the 285 patients diagnosed with COVID-19 (including 12 deaths) during the study period. 9 A previous study of 214 COVID-19 patients (severe disease rate 41.1%) admitted to three centers in Wuhan, China, reported that 36.4% of them had some neurological symptoms, including 5.7% and 0.8% of patients presenting with severe and nonsevere cerebrovascular disease, respectively.…”

<p>Changes in Demographic and Diagnostic Spectra of Patients with Neurological Symptoms Presenting to an Emergency Department During the COVID-19 Pandemic: A Retrospective Cohort Study</p>

“…A completely different observation, however, is the decreasing admission rate for acute neurological disorders, especially acute ischemic stroke that has been reported in temporal association with the pandemic and lockdown measures. 1,2 A decline in emergency department (ED) presentations during the pandemic has also been reported in several countries and across different disciplines. [3][4][5][6] In contrast, pre-COVID-19 assessments have documented a constant rise in the number of patients seeking evaluation and treatment in ED due to neurological symptoms.…”