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Introduction: The COVID-19 pandemic started in Alberta in March 2020 and significantly increased telehealth service use and provision reducing the risk of virus transmission. We examined the change in the number and proportion of virtual visits by physician specialty and condition (chronic obstructive pulmonary diseases [COPD], heart failure [HF], colorectal and lung cancers), as well as associated changes in physician compensation. Methods: A population-based design was used to analyze all processed physician claims comparing the number and proportion of virtual visits and associated physician billings relative to in-person between pre- (2019/2020) and intra-pandemic (2020/2021). Physician compensations were the claim amounts paid by the health insurance. Results: Pre-pandemic (intra-), there were 8,981 (8,897) lung cancer, 9,245 (9,029) colorectal, 37,558 (36,292) HF, and 68,270 (52,308) COPD patients. Each patient had totally 2.3–4.7 (of which 0.4–0.6% were virtual) general practitioner (GP) visits and 0.9–2.3 (0.2–0.7% were virtual) specialist visits per year pre-pandemic. The average number and proportion of per-patient virtual visits to GPs and specialists grew significantly pre- to intra-pandemic by 2,138–4,567%, and 2,201–7,104%, respectively. Given the lower fees of virtual compared with in-person visits, the reduction in physician compensation associated with the increased use of virtual care was estimated at $3.85 million, with $2.44 million attributed to specialist and $1.41 million to GP. Discussion: Utilization of telehealth increased significantly, while the physician billings per patient and physician compensation declined early in the pandemic in Alberta for the four chronic diseases considered. This study forms the basis for future study in understanding the impact of virtual care, now part of the fabric of health care delivery, on quality of care and patient safety, overall health service utilization (such as diagnostic imaging and other investigations), as well as economic impacts to patients, health care systems, and society. [ABSTRACT FROM AUTHOR]

Background and purpose: Influenza vaccination is associated with a longer‐term protective effect against stroke; however, it has a short‐term inflammatory response which may increase short‐term risk of stroke. The aim was to investigate the association between influenza vaccination and short‐term risk of stroke in adults. Methods: Administrative data were obtained from the Alberta Health Care Insurance Plan for all adults in Alberta, Canada, from September 2009 to December 2018. The hazard of any stroke (acute ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage and transient ischaemic attack) within 3, 7, 14, 21 and 30 days of influenza vaccination compared to unexposed time was analysed using Andersen−Gill Cox models, with adjustment for age, sex, anticoagulant use, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, hypertension, income quintile, and rural or urban home location. Results: In the entire cohort consisting of 4,141,209 adults (29,687,899 person‐years), 1,769,565 (42.7%) individuals received at least one vaccination. In total 38,126 stroke events were recorded with 1309 occurring within 30 days of a vaccination event. Influenza vaccination was associated with a significantly reduced hazard of stroke within 3 days (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.73–0.93), 7 days (HR 0.87, 95% CI 0.80–0.95), 14 days (HR 0.87, 95% CI 0.81–0.93), 21 days (HR 0.85, 95% CI 0.80–0.91) and 30 days (HR 0.66, 95% CI 0.65–0.68). Conclusions: An increased early risk associated with vaccination was not observed. The risk of stroke was reduced at all time points within 30 days after influenza vaccination. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to investigate the impact of time interval between start of intravenous thrombolysis (IVT) to start of endovascular thrombectomy (EVT) on stroke outcomes. Methods: Data from the Quality Improvement and Clinical Research (QuICR) provincial stroke registry from Alberta, Canada, were used to identify stroke patients who received IVT and EVT from January 2015 to December 2019. We assessed the impact of the time interval between IVT bolus to EVT puncture (needle-to-puncture times [NPT]) on outcomes. Radiological outcomes included successful initial recanalization (revised Arterial Occlusive Lesion 2b–3), successful initial and final reperfusion (modified thrombolysis in cerebral infarction 2b–3). Clinical outcomes were 90-day modified Rankin Scale (mRS) and mortality. Results: Of the 680 patients, 233 patients (median age: 73, 41% females) received IVT + EVT. Median NPT was 38 min (IQR, 24–60). Arrival during working hours was independently associated with shorter NPT (p < 0.001). Successful initial recanalization and initial and final reperfusion were observed in 12%, 10%, and 83% of patients, respectively. NPT was not associated with initial successful recanalization (OR 0.97 for every 10-min increase of NPT, 95% CI: 0.91–1.04), initial successful reperfusion (OR 1.01, 95% CI: 0.96–1.07), or final successful reperfusion (OR: 1.03, 95% CI: 0.97–1.08). Every 10-min delay in NPT was associated with lower odds of functional independence at 90 days (mRS ≤2; OR: 0.93; 95% CI, 0.88–0.97). Patients with shorter NPT (≤38 min) had lower 90-day mRS scores (median 1 vs. 3; OR: 0.54 [0.31–0.91]) and had lower mortality (6.1% vs. 21.2%; OR, 0.23 [0.10–0.57]) than the longer NPT group. Conclusion: Shorter NPT did not impact reperfusion outcomes but was associated with better clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Pandemics may promote hospital avoidance, and added precautions may exacerbate treatment delays for medical emergencies such as stroke. We sought to evaluate ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic.Methods: We conducted a population-based study, using linked administrative and stroke registry data from Alberta to identify all patients presenting with stroke before the pandemic (Jan. 1, 2016 to Feb. 27, 2020) and in 5 periods over the first pandemic year (Feb. 28, 2020 to Mar. 31, 2021), reflecting changes in case numbers and restrictions. We evaluated changes in hospital admissions, emergency department presentations, thrombolysis, endovascular therapy, workflow times and outcomes.Results: The study included 19 531 patients in the prepandemic period and 4900 patients across the 5 pandemic periods. Presentations for ischemic stroke dropped in the first pandemic wave (weekly adjusted incidence rate ratio [IRR] 0.54, 95% confidence interval [CI] 0.50 to 0.59). Population-level incidence of thrombolysis (adjusted IRR 0.50, 95% CI 0.41 to 0.62) and endovascular therapy (adjusted IRR 0.63, 95% CI 0.47 to 0.84) also decreased during the first wave, but proportions of patients presenting with stroke who received acute therapies did not decline. Rates of patients presenting with stroke did not return to prepandemic levels, even during a lull in COVID-19 cases between the first 2 waves of the pandemic, and fell further in subsequent waves. In-hospital delays in thrombolysis or endovascular therapy occurred in several pandemic periods. The likelihood of in-hospital death increased in Wave 2 (adjusted odds ratio [OR] 1.48, 95% CI 1.25 to 1.74) and Wave 3 (adjusted OR 1.46, 95% CI 1.07 to 2.00). Out-of-hospital deaths, as a proportion of stroke-related deaths, rose during 4 of 5 pandemic periods.Interpretation: The first year of the COVID-19 pandemic saw persistently reduced rates of patients presenting with ischemic stroke, recurrent treatment delays and higher risk of in-hospital death in later waves. These findings support public health messaging that encourages care-seeking for medical emergencies during pandemic periods, and stroke systems should re-evaluate protocols to mitigate inefficiencies. [ABSTRACT FROM AUTHOR]

Introduction: Geographic visualizations have been used to understand disease since the nineteenth century. We developed a software that creates simple visualizations which can be used as a decision support tool for pre-hospital acute stroke transportation planning. In this study, we test the usability of this software to improve user experience and assess the interpretability of the visualizations it produces as it relates to planning and optimizing stroke systems of care. Materials and Methods: Healthcare practitioners and administrators working within the acute stroke system in Alberta, Canada were invited to participate. Participants were randomized to either the geographic visualization or 2-D temporospatial diagrams. Using a standardized script participants were asked to complete tasks and interpret the visualizations produced by the software. The computer screen and audio were recorded. Recordings were transcribed verbatim and analyzed using inductive thematic analyses. The number of errors made and time to task completion were also analyzed. Results: Eighteen participants (8 physicians, 5 healthcare administrators, 3 paramedics, and 2 nurses) were enrolled. Mean age was 41.22 years (SD: 10.55) and 8 participants were female. It took users a mean of 1.59 min (SD: 0.71) to complete all 10 tasks for the geographic visualizations and a mean of 1.08 min (SD: 0.33) to complete all 15 tasks for the 2-D temporospatial diagrams. Map users made a median of 2 errors (IQR: 4), 2-D temporospatial diagram users also made a median of 2 errors (IQR: 1.5). All but one map user correctly interpreted all maps, only three of the eight 2-D temporospatial diagram correctly interpreted all diagrams. In the qualitative analysis three common themes were identified: comments on the user interface, comments on the visualization tool(s), and suggestions for improvement. Most study participants mentioned that the software would be useful in their work. Conclusions: Healthcare professional from several different aspects of stroke care see geographic visualizations in transport decision making to be a useful tool. The software demonstrated high usability. However, several suggestions were made to improve user experience as well as additional features which could be developed and become the subject of future studies. [ABSTRACT FROM AUTHOR]

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AbstractBefore tissue plasminogen activator (tPA) was licensed for use in Canada, in February 1999, the Calgary Regional Stroke Program spearheaded the development and organization of local resources to use thrombolytic therapy in patients who had experienced acute ischemic stroke. In 1996 special permission was obtained from the Calgary Regional Health Authority to use intravenously administered tPA for acute ischemic stroke, and ethical and scientific review boards approved the protocols. After 3 years our efforts have resulted in improved patient outcomes, shorter times from symptom onset to treatment and acceptable adverse event rates. Areas for continued improvement include the door-to-needle time and broader education of the public about the symptoms of acute ischemic stroke. [ABSTRACT FROM AUTHOR]

BACKGROUND: Perinatal stroke encompasses multiple disease-specific cerebrovascular syndromes that cause lifelong neurodevelopmental morbidity for millions worldwide. Acute presentations include neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis, and neonatal hemorrhagic stroke (NHS). Delayed presentations include arterial presumed perinatal ischemic stroke, periventricular venous infarction, and presumed perinatal hemorrhagic stroke. Our objective was to define the birth prevalence of all subtypes of perinatal stroke by using a population-based cohort. METHODS: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in southern Alberta, Canada, with prospective (2008-2017) and retrospective (1990-2008) enrollment leveraging universal health care at a single tertiary care pediatric center. The primary outcome was the estimated birth prevalence of each perinatal stroke syndrome, secondary outcomes were birth prevalence over time, sex ratios, and change in age at diagnosis. Analysis included Poisson regression, Wilcoxon rank test, and Fisher exact test. RESULTS: The overall estimated birth prevalence of term-born perinatal stroke was 1:1100. The estimated birth prevalence was 1:3000 for NAIS, 1:7900 for arterial presumed perinatal ischemic stroke, 1:6000 for periventricular venous infarction, 1:9100 for cerebral sinovenous thrombosis, 1:6800 for NHS, and 1:65000 for presumed perinatal hemorrhagic stroke. The apparent birth prevalence of NAIS and NHS increased over time. There were more males affected than females. The age at diagnosis decreased for late-presenting stroke types. CONCLUSIONS: The estimated birth prevalence of term perinatal stroke is higher than previous estimates, which may be explained by population-based sampling of disease-specific states. This emphasizes the need for further studies to better understand the disease-specific pathophysiology to improve treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Results of randomized controlled trials have shown that carotid endarterectomy poses greater perioperative risks to women than to men. There are limited studies regarding sex differences in carotid angioplasty and stenting. Objectives: To compare male and female patients undergoing carotid stenting with regard to their intraprocedural complications and 30-day outcome. Methods: We reviewed patients who underwent carotid stenting between 1997 and 2007 at our tertiary centre. Distal protection devices were used in all patients after 1999. Demographics, risk factors, intraprocedural complications, and 30-day outcomes were compared between female and male patients. Results: Among 243 patients who underwent 255 procedures, 67 were women (27.6%). The mean (SD) age of the female patients was 72.2 ± 8.4 years and that of the male patients was 72.0 ± 9.6 years (P = .83). The majority of patients had symptomatic carotid artery disease; 11 women (16.4%) and 30 men (16.0%) were asymptomatic. The following intraprocedural complications were noticed in female vs male patients: asymptomatic carotid and/or iliac dissections 7.5% vs 0% (P = .001), minor stroke 0% vs 1.1% (P = 1.00), major stroke 0% vs 0.5% (P = 1.00), and cardiac dysrhythmias 3% vs 2.7% (P = 1.00). At 30 days, the outcomes in women vs men were as follows: mortality 3.0% vs 3.2% (P = 1.00), major stroke 3.0% vs 2.1 % (P = .66), and minor stroke 3.0% vs 3.2% (P = 1.00). Conclusion: Although minor asymptomatic intraprocedural dissections were more common in women, we did not find any impact of sex on the 30-day outcome. We concluded that carotid stenting can be performed as safely in women as in men. [ABSTRACT FROM AUTHOR]