Telestroke for the Treatment of Ischemic Stroke in Western China During the COVID-19 Pandemic: A Multicenter Observational Study

Abstract

BackgroundIntravenous thrombolysis is still underutilized in patients with acute ischemic stroke (AIS) in China. A promising strategy for addressing this issue, especially in situations, such as the global pandemic of coronavirus disease 2019 (COVID-19), is the telestroke mode, which remains to be widely implemented in China. The present study aimed to assess the effects of telemedicine for patients with stroke in Western China, as well as the impact of the pandemic on telestroke services in 1 year after the COVID-19 outbreak.MethodsIn this 2-year multicenter observational study, we retrospectively collected data from 10 hospitals within the Sichuan Telestroke and Telethrombolysis Network. Demographic and clinical characteristics of patients with IS and those relevant to thrombolysis were compared between the pre-telestroke and post-telestroke phases, and between the periods before and after declaration of the COVID-19 pandemic.ResultsA total of 11,449 admissions with a primary diagnosis of IS were recorded during the study period. Prior to telestroke implementation, 6.7% of patients (n = 367) received intravenous thrombolysis, and the proportion increased to 7.4% (n = 443; p = 0.084) in the post-telestroke phase. The thrombolysis rate was 7.4% during the COVID-19 pandemic and in the latter half of the year when the viral spread was better controlled in China. The mean door-to-needle time (DNT) was significantly shorter after implementation of the telestroke network (63.76 ± 13.50 vs. 52.66 ± 25.49 min; p < 0.001).ConclusionsTelemedicine is effective in improving the thrombolysis administration among patients with IS in Western China. Implementation of the telestroke network should be promoted, especially when access to care is affected by public health emergencies, such as the COVID-19 pandemic.

Utilization of Telestroke during Pandemic COVID-19: A Scoping Review

“…The other explanation may includes the quick respon to transport patients to the ward in pandemic situation with overcrowded emergency department, the protected stroke code, as well as a greater experience of local telestroke team (Sevilis, et al 2022). The reason for this also added by Chen, et al (2022), by stated that it was due to lower total number of patients in most hospitals and smoother access to investigations and treatments.…”

“…Hypothetically, the use of technologybase healthcare services, such as telehealth, would likely elevate during the pandemic period due to the social distancing and stay at home regulation that promote to reduce the spread of the virus. The application of telestroke have been proven to be effective to care stroke patient as well as to promote, evaluate and manage the disease, and rehabilitate related to stroke (Chen, 2022). In the contrary, this has been reported that the request for telestroke admission is decreased significantly after WHO declared this pandemic situation.…”

Telestroke’s Role Through the COVID-19 Pandemic and Beyond

“…One pandemic-era report from the Spanish region of Catalonia showed that their 14 TS centers experienced more than 30% reduction in TS code activations and > 50% decrease in thrombolysis treatment in the first 7 weeks following the declaration of the pandemic compared to the 7-week period pre-pandemic [53]. However, reports from western China and Chile each showed that their TS systems and networks did not face any significant reduction in stroke codes or reperfusion therapy in the first year of the pandemic compared to the year before [55,56].…”

Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region

“… 63 Using telemedicine was also effective in improving the thrombolysis administration during the COVID-19 pandemic among Chinese patients who had limited access to hospitals. 64 Current studies worldwide and in WPR during the COVID-19 pandemic showed that the screening and management of CMDs based on dHealth techniques would be efficient ways to guide the high-risk population to carry out lifestyle self-management, non-drug treatments, or medication measurements through remote approaches. By using these techniques, the frequency and duration of hospital visits for CMDs management were largely decreased, and the exposure risk of COVID-19 was also substantially reduced.…”