Acute stroke care in the U.S. was subject to few disruptions during the COVID-19 pandemic, according to registry data.
Among hospitals participating in the Get With The Guidelines (GWTG)-Stroke registry, patients who experienced an acute ischemic stroke during the pandemic were no worse off in receiving intravenous (IV) alteplase and endovascular therapy, and also had similar door-to-CT, door-to-needle, and door-to-endovascular therapy times, reported Gregg Fonarow, MD, of the University of California Los Angeles, and colleagues.
“Although we expected delays for thrombolysis and thrombectomy in our during COVID-19 cohort due to the need for additional personal protective equipment, the relatively preserved door to diagnosis and door to intervention times suggest the donning of personal protective equipment did not lead to delayed patient care,” they wrote in Stroke.
These findings are in contrast to a recent report of a global decline in stroke care (e.g., IV thrombolysis and inter-facility IV thrombolysis transfers) across 70 countries related to the pandemic.
In the present study, weekly stroke presentations dropped by 15.3% on average starting the third week of March 2020 compared with similar months in 2019, a pattern that persisted through the last available stroke entries in the registry in May 2020.
COVID did bring dips in GWTG-Stroke quality measures such as timely IV alteplase administration, prescription of antithrombotics at discharge, dysphagia screening, smoking cessation counseling, stroke education, and rehabilitation consideration.
“Though slightly lower in the during COVID-19 cohort, these quality measures remained above the 85% target, further suggesting maintenance of quality care during the pandemic,” Fonarow and co-authors argued.
There was no change in risk-adjusted inpatient mortality or functional outcomes at discharge between the pre-COVID and COVID eras, they added.
As for discharge disposition, stroke patients during the pandemic were more likely to be discharged to hospice or home, and less likely to be discharged to a skilled nursing facility. There were also shorter hospital stays compared with the pre-pandemic period.
“These trends likely reflect patient and provider hesitancy toward prolonged hospital stays and desire to triage patients away from high-risk environments. They may also reflect competing pressures on beds in both hospital and skilled nursing facilities during the pandemic,” the authors surmised.
Fonarow and colleagues compared 39,113 stroke patients before the first reported case of COVID-19 in the GWTG-Stroke registry (Nov. 1, 2019 to Feb. 3, 2020) with 41,971 patients after (Feb. 4, 2020 to June 29, 2020).
The two groups shared similar characteristics at baseline (median age 71 years, 48.8% women).
Out of more than 2,000 participating hospitals in GWTG-Stroke, 458 had at least one patient who tested positive for SARS-CoV-2 infection. During the pandemic, 2.7% of stroke patients in the registry also had a diagnosis of COVID-19.
Major limitations to the analysis included its retrospective and observational nature. Fonarow and colleagues also acknowledged that the GWTG-Stroke database is subject to a data lag, due to the administrative burden of the pandemic, which may have affected their analysis of stroke volumes during COVID-19.
“The initial wave of COVID-19 overwhelmed medical systems around the world, raising the possibility that decreased stroke presentations may partially reflect a lack of capacity in overburdened health systems,” they wrote. “Shelter in place and social distancing orders, while essential to curb the spread of the disease, may also be contributing to decreases in stroke presentation.”
GWTG-Stroke is a voluntary registry from the American Heart Association/American Stroke Association and, as such, the data may not be generalizable to non-participating stroke centers. The accuracy of the database also relied on manual data abstraction, the authors cautioned.
The study was sponsored by a research contract with Genentech.
GWTG-Stroke is supported by Novartis, the Boehringer Ingelheim and Eli Lilly Diabetes Alliance, Novo Nordisk, Sanofi, AstraZeneca, Bayer, and Portola Pharmaceuticals.
Fonarow reported consulting to Abbott, Amgen, CHF Solutions, Janssen, Medtronic, Merck, and Novartis.