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5. Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

Author

Nogueira, Raul, Qureshi, Muhammad, Abdalkader, Mohamad, Martins, Sheila Ouriques, Yamagami, Hiroshi, Qiu, Zhongming, Mansour, Ossama Yassin, Sathya, Anvitha, Czlonkowska, Anna, Tsivgoulis, Georgios, Aguiar de Sousa, Diana, Demeestere, Jelle, Mikulik, Robert, Vanacker, Peter, Siegler, James, Kõrv, Janika, Biller, Jose, Liang, Conrad, Sangha, Navdeep, Zha, Alicia, Czap, Alexandra, Holmstedt, Christine Anne, Turan, Tanya, Ntaios, George, Malhotra, Konark, Tayal, Ashis, Loochtan, Aaron, Ranta, Annamarei, Mistry, Eva, Alexandrov, Anne, Huang, David, Yaghi, Shadi, Raz, Eytan, Sheth, Sunil, Mohammaden, Mahmoud, Frankel, Michael, Bila Lamou, Eric Guemekane, Aref, Hany, Elbassiouny, Ahmed, Hassan, Farouk, Menecie, Tarek, Mustafa, Wessam, Shokri, Hossam, Roushdy, Tamer, Sarfo, Fred, Alabi, Tolulope Oyetunde, Arabambi, Babawale, Nwazor, Ernest, Sunmonu, Taofiki Ajao, Wahab, Kolawole, Yaria, Joseph, Mohammed, Haytham Hussein, Adebayo, Philip, Riahi, Anis, Sassi, Samia Ben, Gwaunza, Lenon, Ngwende, Gift Wilson, Sahakyan, David, Rahman, Aminur, Ai, Zhibing, Bai, Fanghui, Duan, Zhenhui, Hao, Yonggang, Huang, Wenguo, Li, Guangwen, Li, Wei, Liu, Ganzhe, Luo, Jun, Shang, Xianjin, Sui, Yi, Tian, Ling, Wen, Hongbin, Wu, Bo, Yan, Yuying, Yuan, Zhengzhou, Zhang, Hao, Zhang, Jun, Zhao, Wenlong, Zi, Wenjie, Leung, Thomas, Chugh, Chandril, Huded, Vikram, Menon, Bindu, Pandian, Jeyaraj Durai, Sylaja, Pn, Usman, Fritz Sumantri, Farhoudi, Mehdi, Hokmabadi, Elyar Sadeghi, Horev, Anat, Reznik, Anna, Sivan Hoffmann, Rotem, Ohara, Nobuyuki, Sakai, Nobuyuki, Watanabe, Daisuke, Yamamoto, Ryoo, Doijiri, Ryosuke, Tokuda, Naoki, Yamada, Takehiro, Terasaki, Tadashi, Yazawa, Yukako, Uwatoko, Takeshi, Dembo, Tomohisa, Shimizu, Hisao, Sugiura, Yuri, Miyashita, Fumio, Fukuda, Hiroki, Miyake, Kosuke, Shimbo, Junsuke, Sugimura, Yusuke, Yagita, Yoshiki, Takenobu, Yohei, Matsumaru, Yuji, Yamada, Satoshi, Kono, Ryuhei, Kanamaru, Takuya, Yamazaki, Hidekazu, Sakaguchi, Manabu, Todo, Kenichi, Yamamoto, Nobuaki, Sonoda, Kazutaka, Yoshida, Tomoko, Hashimoto, Hiroyuki, Nakahara, Ichiro, Kondybayeva, Aida, Faizullina, Kamila, Kamenova, Saltanat, Zhanuzakov, Murat, Baek, Jang-Hyun, Hwang, Yangha, Lee, Jin Soo, Lee, Si Baek, Moon, Jusun, Park, Hyungjong, Seo, Jung Hwa, Seo, Kwon-Duk, Sohn, Sung Il, Young, Chang Jun, Ahdab, Rechdi, Wan Zaidi, Wan Asyraf, Aziz, Zariah Abdul, Basri, Hamidon Bin, Chung, Law Wan, Ibrahim, Aznita Binti, Ibrahim, Khairul Azmi, Looi, Irene, Tan, Wee Yong, Yahya, Nafisah Wan, Groppa, Stanislav, Leahu, Pavel, Al Hashmi, Amal, Imam, Yahia Zakaria, Akhtar, Naveed, Pineda-Franks, Maria Carissa, Co, Christian Oliver, Kandyba, Dmitriy, Alhazzani, Adel, Al-Jehani, Hosam, Tham, Carol Huilian, Mamauag, Marlie Jane, Venketasubramanian, Narayanaswamy, Chen, Chih-Hao, Tang, Sung-Chun, Churojana, Anchalee, Akil, Esref, Aykaç, Özlem, Ozdemir, Atilla Ozcan, Giray, Semih, Hussain, Syed Irteza, John, Seby, Le Vu, Huynh, Tran, Anh Duc, Nguyen, Huy Hoang, Nhu Pham, Thong, Nguyen, Thang Huy, Nguyen, Trung Quoc, Gattringer, Thomas, Enzinger, Christian, Killer-Oberpfalzer, Monika, Bellante, Flavio, de Blauwe, Sofie, Vanhooren, Geert, de Raedt, Sylvie, Dusart, Anne, Lemmens, Robin, Ligot, Noemie, Pierre Rutgers, Matthieu, Yperzeele, Laetitia, Alexiev, Filip, Sakelarova, Teodora, Bedeković, Marina Roje, Budincevic, Hrvoje, Cindric, Igor, Hucika, Zlatko, Ozretic, David, Saric, Majda Seferovic, Pfeifer, František, Karpowic, Igor, Cernik, David, Sramek, Martin, Skoda, Miroslav, Hlavacova, Helena, Klecka, Lukas, Koutny, Martin, Vaclavik, Daniel, Skoda, Ondrej, Fiksa, Jan, Hanelova, Katerina, Nevsimalova, Miroslava, Rezek, Robert, Prochazka, Petr, Krejstova, Gabriela, Neumann, Jiri, Vachova, Marta, Brzezanski, Henryk, Hlinovsky, David, Tenora, Dusan, Jura, Rene, Jurák, Lubomír, Novak, Jan, Novak, Ales, Topinka, Zdenek, Fibrich, Petr, Sobolova, Helena, Volny, Ondrej, Krarup Christensen, Hanne, Drenck, Nicolas, Klingenberg Iversen, Helle, Simonsen, Claus, Truelsen, Thomas Clement, Wienecke, Troels, Vibo, Riina, Gross-Paju, Katrin, Toomsoo, Toomas, Antsov, Katrin, Caparros, Francois, Cordonnier, Charlotte, Dan, Maria, Faucheux, Jean-Marc, Mechtouff, Laura, Eker, Omer, Lesaine, Emilie, Ondze, Basile, Peres, Roxane, Pico, Fernando, Piotin, Michel, Pop, Raoul, Rouanet, Francois, Gubeladze, Tatuli, Khinikadze, Mirza, Lobjanidze, Nino, Tsiskaridze, Alexander, Nagel, Simon, Ringleb, Peter Arthur, Rosenkranz, Michael, Schmidt, Holger, Sedghi, Annahita, Siepmann, Timo, Szabo, Kristina, Thomalla, Götz, Palaiodimou, Lina, Sagris, Dimitrios, Kargiotis, Odysseas, Klivenyi, Peter, Szapary, Laszlo, Tarkanyi, Gabor, Adami, Alessandro, Bandini, Fabio, Calabresi, Paolo, Frisullo, Giovanni, Renieri, Leonardo, Sangalli, Davide, Pirson, Anne, Uyttenboogaart, Maarten, van den Wijngaard, Ido, Kristoffersen, Espen Saxhaug, Brola, Waldemar, Fudala, Małgorzata, Horoch-Lyszczarek, Ewa, Karlinski, Michal, Kazmierski, Radoslaw, Kram, Pawel, Rogoziewicz, Marcin, Kaczorowski, Rafal, Luchowski, Piotr, Sienkiewicz-Jarosz, Halina, Sobolewski, Piotr, Fryze, Waldemar, Wisniewska, Anna, Wiszniewska, Malgorzata, Ferreira, Patricia, Ferreira, Paulo, Fonseca, Luisa, Marto, João Pedro, Pinho E Melo, Teresa, Nunes, Ana Paiva, Rodrigues, Miguel, Tedim Cruz, Vítor, Falup-Pecurariu, Cristian, Krastev, Georgi, Mako, Miroslav, de Leciñana, María Alonso, Arenillas, Juan, Ayo-Martin, Oscar, Cruz Culebras, Antonio, Tejedor, Exuperio Diez, Montaner, Joan, Pérez-Sánchez, Soledad, Tola Arribas, Miguel Angel, Rodriguez Vasquez, Alejandro, Mayza, Michael, Bernava, Gianmarco, Brehm, Alex, Machi, Paolo, Fischer, Urs, Gralla, Jan, Michel, Patrik, Psychogios, Marios-Nikos, Strambo, Davide, Banerjee, Soma, Krishnan, Kailash, Kwan, Joseph, Butt, Asif, Catanese, Luciana, Demchuk, Andrew, Field, Thalia, Haynes, Jennifer, Hill, Michael, Khosravani, Houman, Mackey, Ariane, Pikula, Aleksandra, Saposnik, Gustavo, Scott, Courtney Anne, Shoamanesh, Ashkan, Shuaib, Ashfaq, Yip, Samuel, Barboza, Miguel, Barrientos, Jose Domingo, Portillo Rivera, Ligia Ibeth, Gongora-Rivera, Fernando, Novarro-Escudero, Nelson, Blanco, Anmylene, Abraham, Michael, Alsbrook, Diana, Altschul, Dorothea, Alvarado-Ortiz, Anthony, Bach, Ivo, Badruddin, Aamir, Barazangi, Nobl, Brereton, Charmaine, Castonguay, Alicia, Chaturvedi, Seemant, Chaudry, Saqib, Choe, Hana, Choi, Jae, Dharmadhikari, Sushrut, Desai, Kinjal, Devlin, Thomas, Doss, Vinodh, Edgell, Randall, Etherton, Mark, Farooqui, Mudassir, Frei, Don, Gandhi, Dheeraj, Grigoryan, Mikayel, Gupta, Rishi, Hassan, Ameer, Helenius, Johanna, Kaliaev, Artem, Kaushal, Ritesh, Khandelwal, Priyank, Khawaja, Ayaz, Khoury, Naim, Kim, Benny, Kleindorfer, Dawn, Koyfman, Feliks, Lee, Vivien, Leung, Lester, Linares, Guillermo, Linfante, Italo, Lutsep, Helmi, Macdougall, Lisa, Male, Shailesh, Malik, Amer, Masoud, Hesham, Mcdermott, Molly, Mehta, Brijesh, Min, Jiangyong, Mittal, Manoj, Morris, Jane, Multani, Sumeet, Nahab, Fadi, Nalleballe, Krishna, Nguyen, Claude, Novakovic-White, Roberta, Ortega-Gutierrez, Santiago, Rahangdale, Rahul, Ramakrishnan, Pankajavalli, Romero, Jose Rafael, Rost, Natalia, Rothstein, Aaron, Ruland, Sean, Shah, Ruchir, Sharma, Malveeka, Silver, Brian, Simmons, Marc, Singh, Abhishek, Starosciak, Amy, Strasser, Sheryl, Szeder, Viktor, Teleb, Mohamed, Tsai, Jenny, Voetsch, Barbara, Balaguera, Oscar, Pujol Lereis, Virginia, Luraschi, Adriana, Almeida, Marcele Schettini, Cardoso, Fabricio Buchdid, Conforto, Adriana, de Deus Silva, Leonardo, Varrone Giacomini, Luidia, Oliveira Lima, Fabricio, Longo, Alexandre, Magalhães, Pedro, Martins, Rodrigo Targa, Mont'Alverne, Francisco, Mora Cuervo, Daissy Liliana, Costa Rebello, Leticia, Valler, Lenise, Zetola, Viviane Flumignan, Lavados, Pablo, Navia, Victor, Olavarría, Verónica, Almeida Toro, Juan Manuel, Amaya, Pablo Felipe Ricardo, Bayona, Hernan, Corredor, Angel, Rivera Ordonez, Carlos Eduardo, Mantilla Barbosa, Diana Katherine, Lara, Osvaldo, Patiño, Mauricio, Diaz Escobar, Luis Fernando, Dejesus Melgarejo Fariña, Donoband Edson, Cardozo Villamayor, Analia, Zelaya Zarza, Adolfo Javier, Barrientos Iman, Danny Moises, Rodriguez Kadota, Liliana, Campbell, Bruce, Hankey, Graeme, Hair, Casey, Kleinig, Timothy, Ma, Alice, Tomazini Martins, Rodrigo, Sahathevan, Ramesh, Thijs, Vincent, Salazar, Daniel, Yuan-Hao Wu, Teddy, Haussen, Diogo, Liebeskind, David, Yavagal, Dileep, Jovin, Tudor, Zaidat, Osama, Nguyen, Thanh, Magalhães, Pedro S.C., Emory University School of Medicine, Emory University [Atlanta, GA], Boston University School of Medicine (BUSM), Boston University [Boston] (BU), Lille Neurosciences & Cognition - U 1172 (LilNCog), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Max Super Speciality Hospital -Saket [New Delhi, Inde] (Max Saket), Dupuis, Christine, Lille Neurosciences & Cognition - U 1172 (LilNCog (ex-JPARC)), and Repositório da Universidade de Lisboa

Subjects
medicine.medical_specialty, MESH: Pandemics, HSJ NEU, Cross-sectional study, medicine.medical_treatment, [SDV]Life Sciences [q-bio], SVIN COVID-19 Global Stroke Registry, MESH: Hospitalization, 030204 cardiovascular system & hematology, Article, MESH: Stroke, COVID-19, cross-sectional studies, hospitalization, humans, pandemics, retrospective studies, SARS-CoV-2, stroke, 03 medical and health sciences, 0302 clinical medicine, MESH: Cross-Sectional Studies, Pandemic, Medicine, Humans, MESH: COVID-19, Thrombolytic Therapy, MESH: SARS-CoV-2, Stroke, Pandemics, Retrospective Studies, MESH: Thrombolytic Therapy, Rehabilitation, MESH: Humans, business.industry, Retrospective cohort study, MESH: Retrospective Studies, medicine.disease, Thrombolysis, Confidence interval, 3. Good health, Hospitalization, [SDV] Life Sciences [q-bio], Clinical research, Cross-Sectional Studies, Emergency medicine, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

© 2021 American Academy of Neurology, Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

Published
2021

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