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

Raul G. Nogueira; Muhammad M. Qureshi; Mohamad Abdalkader; Sheila Ouriques Martins; Hiroshi Yamagami; Zhongming Qiu; Ossama Yassin Mansour; Anvitha Sathya; Anna Czlonkowska; Georgios Tsivgoulis; Diana Aguiar de Sousa; Jelle Demeestere; Robert Mikulik; Peter Vanacker; James E. Siegler; Janika Korv; Jose Biller; Conrad W. Liang; Navdeep S. Sangha; Alicia M. Zha; Alexandra L. Czap; Christine Anne Holmstedt; Tanya N. Turan; George Ntaios; Konark Malhotra; Ashis Tayal; Aaron Loochtan; Annamarei Ranta; Eva A. Mistry; Anne W. Alexandrov; David Y. Huang; Shadi Yaghi; Eytan Raz; Sunil A. Sheth; Mahmoud H. Mohammaden; Michael Frankel; Eric Guemekane Bila Lamou; Hany M. Aref; Ahmed Elbassiouny; Farouk Hassan; Tarek Menecie; Wessam Mustafa; Hossam M. Shokri; Tamer Roushdy; Fred S. Sarfo; Tolulope Oyetunde Alabi; Babawale Arabambi; Ernest O. Nwazor; Taofiki Ajao Sunmonu; SVIN COVID-19 Global Stroke Registry; Anne Pirson

doi:10.1212/WNL.0000000000011885

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

Raul G. Nogueira^*, Muhammad M. Qureshi, Mohamad Abdalkader, Sheila Ouriques Martins, Hiroshi Yamagami, Zhongming Qiu, Ossama Yassin Mansour, Anvitha Sathya, Anna Czlonkowska, Georgios Tsivgoulis, Diana Aguiar de Sousa, Jelle Demeestere, Robert Mikulik, Peter Vanacker, James E. Siegler, Janika Korv, Jose Biller, Conrad W. Liang, Navdeep S. Sangha, Alicia M. ZhaAlexandra L. Czap, Christine Anne Holmstedt, Tanya N. Turan, George Ntaios, Konark Malhotra, Ashis Tayal, Aaron Loochtan, Annamarei Ranta, Eva A. Mistry, Anne W. Alexandrov, David Y. Huang, Shadi Yaghi, Eytan Raz, Sunil A. Sheth, Mahmoud H. Mohammaden, Michael Frankel, Eric Guemekane Bila Lamou, Hany M. Aref, Ahmed Elbassiouny, Farouk Hassan, Tarek Menecie, Wessam Mustafa, Hossam M. Shokri, Tamer Roushdy, Fred S. Sarfo, Tolulope Oyetunde Alabi, Babawale Arabambi, Ernest O. Nwazor, Taofiki Ajao Sunmonu, SVIN COVID-19 Global Stroke Registry, Anne Pirson

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	E2824-E2838
Number of pages	15
Journal	Neurology
Volume	96
Issue number	23
DOIs	https://doi.org/10.1212/WNL.0000000000011885
Publication status	Published - 8 Jun 2021

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10.1212/WNL.0000000000011885

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Nogueira, R. G., Qureshi, M. M., Abdalkader, M., Martins, S. O., Yamagami, H., Qiu, Z., Mansour, O. Y., Sathya, A., Czlonkowska, A., Tsivgoulis, G., Aguiar de Sousa, D., Demeestere, J., Mikulik, R., Vanacker, P., Siegler, J. E., Korv, J., Biller, J., Liang, C. W., Sangha, N. S., ... Pirson, A. (2021). Global Impact of COVID-19 on Stroke Care and IV Thrombolysis. Neurology, 96(23), E2824-E2838. https://doi.org/10.1212/WNL.0000000000011885

@article{3b21cc7d7cac479cb7ef3093b8bb8c17,

title = "Global Impact of COVID-19 on Stroke Care and IV Thrombolysis",

abstract = "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.",

author = "Nogueira, {Raul G.} and Qureshi, {Muhammad M.} and Mohamad Abdalkader and Martins, {Sheila Ouriques} and Hiroshi Yamagami and Zhongming Qiu and Mansour, {Ossama Yassin} and Anvitha Sathya and Anna Czlonkowska and Georgios Tsivgoulis and {Aguiar de Sousa}, Diana and Jelle Demeestere and Robert Mikulik and Peter Vanacker and Siegler, {James E.} and Janika Korv and Jose Biller and Liang, {Conrad W.} and Sangha, {Navdeep S.} and Zha, {Alicia M.} and Czap, {Alexandra L.} and Holmstedt, {Christine Anne} and Turan, {Tanya N.} and George Ntaios and Konark Malhotra and Ashis Tayal and Aaron Loochtan and Annamarei Ranta and Mistry, {Eva A.} and Alexandrov, {Anne W.} and Huang, {David Y.} and Shadi Yaghi and Eytan Raz and Sheth, {Sunil A.} and Mohammaden, {Mahmoud H.} and Michael Frankel and {Bila Lamou}, {Eric Guemekane} and Aref, {Hany M.} and Ahmed Elbassiouny and Farouk Hassan and Tarek Menecie and Wessam Mustafa and Shokri, {Hossam M.} and Tamer Roushdy and Sarfo, {Fred S.} and Alabi, {Tolulope Oyetunde} and Babawale Arabambi and Nwazor, {Ernest O.} and Sunmonu, {Taofiki Ajao} and {SVIN COVID-19 Global Stroke Registry} and Anne Pirson",

year = "2021",

month = jun,

day = "8",

doi = "10.1212/WNL.0000000000011885",

language = "English",

volume = "96",

pages = "E2824--E2838",

journal = "Neurology",

issn = "0028-3878",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "23",

}

Nogueira, RG, Qureshi, MM, Abdalkader, M, Martins, SO, Yamagami, H, Qiu, Z, Mansour, OY, Sathya, A, Czlonkowska, A, Tsivgoulis, G, Aguiar de Sousa, D, Demeestere, J, Mikulik, R, Vanacker, P, Siegler, JE, Korv, J, Biller, J, Liang, CW, Sangha, NS, Zha, AM, Czap, AL, Holmstedt, CA, Turan, TN, Ntaios, G, Malhotra, K, Tayal, A, Loochtan, A, Ranta, A, Mistry, EA, Alexandrov, AW, Huang, DY, Yaghi, S, Raz, E, Sheth, SA, Mohammaden, MH, Frankel, M, Bila Lamou, EG, Aref, HM, Elbassiouny, A, Hassan, F, Menecie, T, Mustafa, W, Shokri, HM, Roushdy, T, Sarfo, FS, Alabi, TO, Arabambi, B, Nwazor, EO, Sunmonu, TA, SVIN COVID-19 Global Stroke Registry & Pirson, A 2021, 'Global Impact of COVID-19 on Stroke Care and IV Thrombolysis', Neurology, vol. 96, no. 23, pp. E2824-E2838. https://doi.org/10.1212/WNL.0000000000011885

TY - JOUR

T1 - Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

AU - Nogueira, Raul G.

AU - Qureshi, Muhammad M.

AU - Abdalkader, Mohamad

AU - Martins, Sheila Ouriques

AU - Yamagami, Hiroshi

AU - Qiu, Zhongming

AU - Mansour, Ossama Yassin

AU - Sathya, Anvitha

AU - Czlonkowska, Anna

AU - Tsivgoulis, Georgios

AU - Aguiar de Sousa, Diana

AU - Demeestere, Jelle

AU - Mikulik, Robert

AU - Vanacker, Peter

AU - Siegler, James E.

AU - Korv, Janika

AU - Biller, Jose

AU - Liang, Conrad W.

AU - Sangha, Navdeep S.

AU - Zha, Alicia M.

AU - Czap, Alexandra L.

AU - Holmstedt, Christine Anne

AU - Turan, Tanya N.

AU - Ntaios, George

AU - Malhotra, Konark

AU - Tayal, Ashis

AU - Loochtan, Aaron

AU - Ranta, Annamarei

AU - Mistry, Eva A.

AU - Alexandrov, Anne W.

AU - Huang, David Y.

AU - Yaghi, Shadi

AU - Raz, Eytan

AU - Sheth, Sunil A.

AU - Mohammaden, Mahmoud H.

AU - Frankel, Michael

AU - Bila Lamou, Eric Guemekane

AU - Aref, Hany M.

AU - Elbassiouny, Ahmed

AU - Hassan, Farouk

AU - Menecie, Tarek

AU - Mustafa, Wessam

AU - Shokri, Hossam M.

AU - Roushdy, Tamer

AU - Sarfo, Fred S.

AU - Alabi, Tolulope Oyetunde

AU - Arabambi, Babawale

AU - Nwazor, Ernest O.

AU - Sunmonu, Taofiki Ajao

AU - SVIN COVID-19 Global Stroke Registry

AU - Pirson, Anne

PY - 2021/6/8

Y1 - 2021/6/8

N2 - 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.

AB - 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.

U2 - 10.1212/WNL.0000000000011885

DO - 10.1212/WNL.0000000000011885

M3 - Article

SN - 0028-3878

VL - 96

SP - E2824-E2838

JO - Neurology

JF - Neurology

IS - 23

ER -