A national study conducted by researchers in the Czech Republic has found that, while stroke admissions in the country declined during the first year of the COVID-19 pandemic, this was not related to the incidence of the virus.
The study’s authors—Petra Sedova (St Anne’s University Hospital, Pekarska, Czech Republic) and colleagues—also report that the frequency of use of recanalisation procedures for acute ischaemic stroke like intravenous thrombolysis (IVT) and mechanical thrombectomy, as well as treatment times including ‘onset-to-door’ and ‘door-to-needle’, were “preserved” during the first year of the pandemic in the Czech Republic.
“During the COVID-19 pandemic, many countries reported a decline in stroke volumes,” the authors write, laying out the context within which their research was conducted in the European Journal of Neurology. “The aim of this study was to analyse if the decline was related to the intensity of the COVID-19 pandemic.”
To achieve this, they compared the first year of the pandemic (1 March 2020 to 28 February 2021), and the three major COVID-19 waves, to the immediately preceding year. Volumes of acute ischaemic stroke, subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH), and recanalisation treatments—IVT and thrombectomy—were obtained from the country’s National Register of Reimbursed Health Services. In addition, door-to-needle and onset-to-door times, and National Institutes of Health Stroke Scale (NIHSS) scores at admission, were obtained from the Registry of Stroke Care Quality.
Sedova and colleagues further posit that one of the “biggest strengths” of their study is its nationwide data coverage.
During the pandemic year, as compared to the preceding year, there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p<0.001), they report. Declines in admissions were seen during the three major waves of infections (−10% in spring 2020, −11% in autumn 2020 and −19% in winter 2021), but a slight increase (2%) was observed during summer 2020.
Admissions for acute ischaemic stroke declined by 10.2% (p<0.001) during the pandemic year versus the prior 12 months, representing a statistically significant decrease. However, haemorrhagic stroke admissions “remained stable”, with only a slight drop in the number of admitted patients with SAH (−3.2%, p=0.48) and with ICH (−0.8%, p=0.77).
The absolute volumes of IVT and mechanical thrombectomy decreased by 9.4% (p<0.001) and 5.7% (p=0.16), respectively, according to the authors, but the proportions of ischaemic stroke patients receiving IVT (18% vs 18%, p=0.72) and thrombectomy (6% vs 6%, p=0.28) remained unchanged.
“Comparing the first pandemic year to the previous year, the age of the admitted ischaemic stroke patients and the relative proportion of male patients remained unchanged for all stroke types,” Sedova and colleagues note.
The authors go on to report that hospital admission rates for acute ischaemic stroke “fell significantly” during all COVID-19 waves—with the most significant reduction being observed during the winter 2021 wave, as hospitalisations decreased by 21.6% (p<0.001) in comparison to the previous year.
“The most relevant results of our analysis are twofold,” Sedova and colleagues state. “First, a significant decline in hospitalisations for total stroke during all COVID-19 waves, regardless of COVID-19 incidence, was found. Secondly, stroke hospital admissions returned to pre-pandemic levels during summer 2020, when the COVID-19 cases were low and the pandemic was considered to be over.”
The authors note that the decrease in absolute volume of IVT procedures—but with a preserved relative proportion of stroke patients receiving such procedures—in all COVID-19 waves, returning to pre-pandemic levels during summer 2020, is comparable to reported results from Canada and Germany. And, while their finding of declining thrombectomy volumes contradicts German research indicating an observed increase in these procedures during the first pandemic year, data from Denmark have showed “no change” in the number of both thrombectomy and IVT procedures in this time.
“The time to initiation of reperfusion therapy was unchanged, suggesting that stroke management quality in the earliest stages of acute ischaemic stroke was preserved,” Sedova and colleagues conclude.
“The unchanged NIHSS at admission would be consistent with the avoidance of hospital visits irrespective of stroke severity. As the pandemic continues, it is imperative that the public has increased awareness of the consequences of untreated serious medical conditions like stroke.”