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

Abstract

Background and purpose:The experience gained during the first COVID-19 wave could have mitigated the negative impact on stroke care in the following waves. Our aims were to analyze the characteristics and outcomes of patients with stroke admitted during the second COVID-19 wave and to evaluate the differences in the stroke care provision compared with the first wave. Methods: This retrospective multicenter cohort study included consecutive stroke patients admitted to any of the seven hospitals with stroke units (SUs) and endovascular treatment facilities in the Madrid Health Region. The characteristics of the stroke patients with or without a COVID-19 diagnosis were compared and the organizational changes in stroke care between the first wave (25 February to 25 April 2020) and second wave (21 July to 21 November 2020) were analyzed.Results: A total of 550 and 1191 stroke patients were admitted during the first and second COVID-19 waves, respectively, with an average daily admission rate of nine patients in both waves. During the second wave, there was a decrease in stroke severity (median National Institutes of Health Stroke Scale 5 vs. 6; p = 0.000), in-hospital strokes (3% vs. 8.1%) and in-hospital mortality (9.9% vs. 15.9%). Furthermore, fewer patients experienced concurrent , and they presented milder COVID-19 and less severe strokes. Fewer hospitals reported a reduction in the number of SU beds or deployment of SU personnel to COVID-19 dedicated wards during the second wave. Conclusions:During the second COVID-19 wave, fewer stroke patients were diagnosed with COVID-19, and they had less stroke severity and milder COVID-19.

Stroke mortality during the second wave of the COVID‐19 pandemic: Is it getting any better?

“…The impact of the second wave of the COVID-19 pandemic on stroke care is still uncertain, as evidence from publications is now gradually emerging. In the current issue of the European Journal of and in-hospital stroke mortality compared to the first wave of the pandemic [8]. They also report that during the second wave in their region fewer stroke patients were infected by SARS-CoV-2, and when infected they had milder symptoms and lower risk for mortality compared to the first wave of the pandemic (9.9% vs. 15.9%) [8].…”

“…In the current issue of the European Journal of and in-hospital stroke mortality compared to the first wave of the pandemic [8]. They also report that during the second wave in their region fewer stroke patients were infected by SARS-CoV-2, and when infected they had milder symptoms and lower risk for mortality compared to the first wave of the pandemic (9.9% vs. 15.9%) [8]. This report from a region in Spain contradicts with the findings of a nationwide analysis from Germany by Richter et al…”

“…The impact of the second wave of the COVID‐19 pandemic on stroke care is still uncertain, as evidence from publications is now gradually emerging. In the current issue of the European Journal of Neurology , Fuentes et al analyze the characteristics and outcomes of patients with stroke admitted during the second wave of the COVID‐19 pandemic in the Madrid region and evaluate the differences in the stroke care provision compared with the first wave of the pandemic [ 8 ]. Fuentes et al report that during the second wave, there was a decrease in stroke severity, in‐hospital strokes, and in‐hospital stroke mortality compared to the first wave of the pandemic [ 8 ].…”

“…In the current issue of the European Journal of Neurology , Fuentes et al analyze the characteristics and outcomes of patients with stroke admitted during the second wave of the COVID‐19 pandemic in the Madrid region and evaluate the differences in the stroke care provision compared with the first wave of the pandemic [ 8 ]. Fuentes et al report that during the second wave, there was a decrease in stroke severity, in‐hospital strokes, and in‐hospital stroke mortality compared to the first wave of the pandemic [ 8 ]. They also report that during the second wave in their region fewer stroke patients were infected by SARS‐CoV‐2, and when infected they had milder symptoms and lower risk for mortality compared to the first wave of the pandemic (9.9% vs. 15.9%) [ 8 ].…”

“…Fuentes et al report that during the second wave, there was a decrease in stroke severity, in‐hospital strokes, and in‐hospital stroke mortality compared to the first wave of the pandemic [ 8 ]. They also report that during the second wave in their region fewer stroke patients were infected by SARS‐CoV‐2, and when infected they had milder symptoms and lower risk for mortality compared to the first wave of the pandemic (9.9% vs. 15.9%) [ 8 ]. This report from a region in Spain contradicts with the findings of a nationwide analysis from Germany by Richter et al reporting similar in‐hospital mortality rates (8.0%) during the first and second waves of the COVID‐19 pandemic, while highlight a 30% increase in mortality rates of hospitalized ischemic stroke patients infected with SARS‐CoV‐2 during the second wave when compared to the first wave of the COVID‐19 pandemic in Germany [ 9 ].…”