Understanding and Informing Community Emergency Cardiovascular Disease Preparedness during the COVID-19 Pandemic: Stroke Ready

Abstract

Introduction: Acute stroke and acute myocardial infarction (AMI) treatments are time sensitive. Early data revealed a decrease in presentation and an increase in pre-hospital delay for acute stroke and AMI during the coronavirus disease 2019 (COVID-19) pandemic. Thus, we set out to understand community members' perception of seeking acute stroke and AMI care during the COVID-19 pandemic to inform strategies to increase cardiovascular disease preparedness during the pandemic. Methods: Given the urgency of the clinical and public health situation, through a community-based participatory research partnership, we utilized a rapid assessment approach. We developed an interview guide and data collection form guided by the Theory of Planned Behavior (TPB). Semi-structured interviews were recorded and conducted via phone and data was collected on structured collection forms and real time transcription. Direct content analysis was conducted guided by the TPB model and responses for AMI and stroke were compared. Results: We performed 15 semi-structured interviews. Eighty percent of participants were Black Americans; median age was 50; 73% were women. Participants reported concerns about coronavirus transmission in the ambulance and at the hospital, hospital capacity and ability to triage, and quality of care. Change in employment and childcare also impacted participants reported control over seeking emergent cardiovascular care. Based on these findings, our community and academic team co-created online materials to address the community-identified barriers, which has reached over 8,600 users and engaged almost 600 users. Conclusions: We found that community members' attitudes and perceived behavioral control to seek emergent cardiovascular care were impacted by the COVID-19 pandemic. Community-informed, health behavior theory-based public health messaging that address these constructs may decrease prehospital delay.

Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown

“…Similar to our study, a survey of stroke centres in China showed a 45% reduction in TIA and 32% in stroke admissions in mild epidemic regions, as well as overall increased delays to acute stroke care [ 33 ]. Although the reasons for increased onset-to-door delays are unclear, fear of virus exposure in the ambulance or at the hospital and absence of bystanders to initiate the stroke alarm during social distancing mandate might have delayed initiation of the EMS call [ 34 ]. Also, the need to perform additional respiratory screening and use of personal protective equipment could increase prehospital delays.…”

Dynamic Topic Modelling for Exploring the Scientific Literature on Coronavirus: An Unsupervised Labelling Technique

“…The T 89 until 1990, from 2008 to 2018, and the years 2020 and 2021; the T 28 from 1990 to 2007; the T 46 in 2019; and the T 64 in 2022. Between domains T 93 and T 89 , the most relevant works are: a paper on community preparedness for cardiovascular emergencies during the COVID-19 pandemic [68]; and a comparison of arrhythmia diagnosis in human-dependent versus algorithm-dependent systems [69]. At the date of these articles (2021), as we mentioned previously, the labels of the T 89 topic are "assay" and "detection".…”

Family Experience of Stroke Patients Regarding Prehospital Time: A Phenomenological Study

“…corona in the ambulance and in the hospital. Community members' attitudes and perceived behavioral control to seek emergency cardiovascular care are affected by the COVID-19 pandemic (Robles et al, 2021).…”