Fewer Hospital Visits for Acute Stroke and Acute Coronary Syndrome During the COVID-19 Pandemic: A Reality or a Myth?

Seifi, Ali; Stowers, Jared Alexander; Behrouz, Réza

doi:10.14740/jnr601

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…Another potential deterrent for patients and their relatives could be the fear of acquiring the coronavirus infection at the hospital. 12 The major group that has been affected in our study is those that reside geographically further away from the hospital. Those patients whose residence was not within the city or town limits of the hospital were less likely to seek care, with only a third of the number presenting during the lockdown period.…”

Section: Discussionmentioning

confidence: 93%

Gender and Regional Disparities in Emergency Arrhythmia Procedures During Covid-19 Lockdown

2022

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Objectives: Worldwide reduction in emergency procedures has been observed during the current COVID-19 pandemic. The effects of the pandemic and its associated lockdown on arrhythmia related emergency procedures is not known. This study was done to see the effects of the COVID-19 pandemic lockdown on provision of emergency arrhythmia procedures and to identify vulnerable patient groups that may be disproportionately affected during lockdown. Methodology: Data for patients requiring emergency intracardiac devices including temporary and permanent pacemakers was collected from three public sector hospitals of Sindh, Pakistan, for the COVID-19 lockdown period of March to May 2020. This was compared to the data for the same period for 2019. Results: Patients presenting during lockdown decreased by 32.8% (from 250 to 168) compared to the same period without lockdown. The decline was across all emergency procedures considered. There was a more than fivefold reduction in the number of patients in patients from outside the metropolitan area of the hospital (64.3%) compared to those residing within the city (12.5%) (p=0.001). There was a trend showing women to be more effected, with the percentage decline in women being statistically significant in the rural setting (-93.8% vs. -52.9%, p=0.043). All age groups were equally affected (p=0.152). Conclusion: A marked reduction in the number of patients who presented for emergency intra cardiac devices and TPM procedures was seen during COVID-19 lockdown. The patients who presented from outside the city of the hospital and women in rural setting were significantly more effected.

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Section: Discussionmentioning

confidence: 93%

Gender and Regional Disparities in Emergency Arrhythmia Procedures During Covid-19 Lockdown

2022

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“…The lockdowns and simplification of routines may have encouraged medication adherence and control of chronic disease states, as well as potentially decreased access to high sodium meals prepared in dining establishments. Travel and outing restrictions yielded less opportunity for exertion injuries, falls, and motor vehicle accidents, as well as decreased transmission of respiratory pathogens known to exacerbate preexisting conditions [8]. However, it may also be true that fewer outpatient visits were scheduled/attended; patients may not have received their routine preventive care or stroke follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…The first documented COVID-19 case in the USA was in January 2020, and the ensuing lockdown restrictions and fear of virus exposure may have discouraged patients to present to the hospital with findings concerning for stroke. It has also been suggested that some stroke patients deferred emergency services and died at home during the pandemic, and even others may have presumed that their hospitals and clinics were closed to non-COVID-19 patients [8]. A multinational study found that stroke services were affected by the pandemic, with younger patients, higher NIHSS at admission and mRS at discharge, higher hemorrhagic stroke prevalence, longer door-to-needle time, decreased tPA administration, and increased thrombectomy frequency [9].…”

Section: Discussionmentioning

confidence: 99%

Two Decades of Stroke in the United States: A Healthcare Economic Perspective

Lorio,

Garcia-Rodriguez,

Seifi

2024

Neuroepidemiology

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Background: Stroke is a leading cause of morbidity and mortality in the United States and has implications on the financial health of patients, families, and healthcare systems. Objective: This study aims to determine the economic perspective of stroke on the national healthcare system for the past two decades. Methods: This retrospective study of inpatient subjects from 2000 to 2020 with stroke was collected from the Healthcare Cost and Utilization Project (HCUP). We queried patients admitted primarily for ischemic or hemorrhagic stroke. Patients were evaluated for demographics, length of stay (LOS), mortality, and hospital charges. Statistical Z-testing with a significance of p<0.05 was conducted for the analysis. Results: During the study period, 12,158,747 stroke subjects were studied, with 51.9% female and a mean age of 70.08 (±0.16) years old. The mean rate of stroke discharges per 100,000 persons was 187.71 (±3.44), decreasing from 200 to 193 during the study (p=0.16). The mean percentage of deaths was 8.78% (±0.17), which decreased from 10.96% to 6.81% (p=0.00). The mean LOS was 6.28 days (±0.08), increased from 6.70 to 7.15 (p=0.00). During the study period, the aggregated national bill was $725 billion. The mean hospital charges-per-patient were $57,178 (±1,504), increasing from $19,647 to $121,765 per person during the study period (p=0.00), while mean hospital costs-per-stay were $15,781 (±330). These data closely conform to an exponential growth pattern, and forecasting per-patient charges for the next ten years demonstrates a cost of $287,836 by 2030. Conclusions: Our data show that the rate and mortality of stroke have decreased, but its charges and costs are increasing. The improvement in outcomes could be multifactorial such as establishment of comprehensive stroke centers and evolving treatment modalities. Ironically, the charges-per-patient increased more than sixfold with a national bill almost equal to the annual Medicare budget. Thus, the significance of preventive medicine, such as controlling hypertension, diabetes, and smoking cessation, cannot be understated. With such a dramatically increasing financial burden, improvements in mitigating risk factors, educational programs, and access to care may be a more cost-effective option.

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“…The overall concern about contracting the virus and the adherence to social distancing guidelines are presumed to have contributed to the decrease in the number of cases across various disciplines,5 15 22 resulting in a higher fatality rate due to delayed hospitalisation 23 24. Some studies indicated that a general reluctance to seek medical advice among men within the pandemic led to a decrease in severe cases and to higher mortality rates while dying at home 25 26…”

Section: Introductionmentioning

confidence: 99%

Sex-specific Impact of the first COVID-19 Lockdown on Age Structure and Case Acuity at Admission in a Patient Population in southwestern Germany: a retrospective comparative Study in Neuroradiology

Reder,

Herrlich,

Grauhan

et al. 2024

BMJ Open

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ObjectivesA hard lockdown was presumed to lead to delayed diagnosis and treatment of serious diseases, resulting in higher acuity at admission. This should be elaborated based on the estimated acuity of the cases, changes in findings during hospitalisation, age structure and biological sex.DesignRetrospective monocentric cross-sectional study.SettingGerman Neuroradiology Department at a .ParticipantsIn 2019, n=1158 patients were admitted in contrast to n=884 during the first hard lockdown in 2020 (11th–13th week).Main outcome measuresThree radiologists evaluated the initial case acuity, classified them into three groups (not acute, subacute and acute), and evaluated if there was a relevant clinical deterioration. The data analysis was conducted using non-parametric methods and multivariate regression analysis.ResultsA 24% decrease in the number of examinations from 2019 to 2020 (p=0.025) was revealed. In women, the case acuity increased by 21% during the lockdown period (p=0.002). A 30% decrease in acute cases in men was observable (in women 5% decrease). Not acute cases decreased in both women and men (47%; 24%), while the subacute cases remained stable in men (0%) and decreased in women (28%). Regression analysis revealed the higher the age, the higher the acuity (p<0.001 in both sexes), particularly among women admitted during the lockdown period (p=0.006).ConclusionThe lockdown led to a decrease in neuroradiological consultations, with delays in seeking medical care. In women, the number of most severe cases remained stable, whereas the mean case acuity and age increased. This could be due to greater pandemic-related anxiety among women, however, with severe symptoms they were seeking for medical help. In contrast in men, the absolute number of most severe cases decreased, whereas the mean acuity and age remained nearly unaffected. This could be attributable to a reduced willingness to seek for medical consultation.

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Fewer Hospital Visits for Acute Stroke and Acute Coronary Syndrome During the COVID-19 Pandemic: A Reality or a Myth?

Cited by 5 publications

References 8 publications

Gender and Regional Disparities in Emergency Arrhythmia Procedures During Covid-19 Lockdown

Gender and Regional Disparities in Emergency Arrhythmia Procedures During Covid-19 Lockdown

Two Decades of Stroke in the United States: A Healthcare Economic Perspective

Sex-specific Impact of the first COVID-19 Lockdown on Age Structure and Case Acuity at Admission in a Patient Population in southwestern Germany: a retrospective comparative Study in Neuroradiology

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