Abstract
BACKGROUND AND PURPOSE: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. METHODS: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). RESULTS: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. CONCLUSIONS: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers. GRAPHIC ABSTRACT: An online graphic abstract is available for this article.
Original language | English |
---|---|
Pages (from-to) | 1693-1701 |
Number of pages | 9 |
Journal | Stroke |
Volume | 52 |
Issue number | 5 |
Early online date | 2021 |
DOIs | |
Publication status | Published - 2021 |
Keywords
- COVID-19
- Intracranial hemorrhage
- Ischemic stroke
- Quality of care
- Reperfusion
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In: Stroke, Vol. 52, No. 5, 2021, p. 1693-1701.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Maintenance of Acute Stroke Care Service during the COVID-19 Pandemic Lockdown
AU - Altersberger, Valerian L.
AU - Stolze, Lotte J.
AU - Heldner, Mirjam R.
AU - Henon, Hilde
AU - Martinez-Majander, Nicolas
AU - Hametner, Christian
AU - Nordanstig, Annika
AU - Zini, Andrea
AU - Nannoni, Stefania
AU - Goncąlves, Bruno
AU - Nolte, Christian H.
AU - Baumgartner, Philipp
AU - Kastrup, Andreas
AU - Papanagiotou, Panagiotis
AU - Kägi, Georg
AU - Leker, Ronen R.
AU - Zedde, Marialuisa
AU - Padovani, Alessandro
AU - Pezzini, Alessandro
AU - Padjen, Visnja
AU - Cereda, Carlo W.
AU - Ntaios, Georges
AU - Bonati, Leo H.
AU - Rinkel, Leon A.
AU - Fischer, Urs
AU - Scheitz, Jan F.
AU - Wegener, Susanne
AU - Turc, Guillaume
AU - Michel, Patrik
AU - Gentile, Mauro
AU - Rentzos, Alexandros
AU - Ringleb, Peter A.
AU - Curtze, Sami
AU - Cordonnier, Charlotte
AU - Arnold, Marcel
AU - Nederkoorn, Paul J.
AU - Engelter, Stefan T.
AU - Gensicke, Henrik
N1 - Funding Information: Dr Heldner reports personal fees from Bayer and scientific advisory board honoraria from Amgen and a grant from Bangerter foundation, all outside the submitted work. Dr Zini reports personal fees from Stryker, personal fees from Medtronic, personal fees from Cerenovus, personal fees from Daiichi Sankyo, and personal fees from Boehringer Ingelheim outside the submitted work. Dr Nannoni reports grants from Swiss National Science Foundation (SNSF) outside the submitted work. Dr Gonçalves reports funding from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES) Finance Code 001. Dr Nolte reports research grants from German Ministry of Research and Education, German Center for Neurodegenerative Diseases, German Center for Cardiovascular Research, and speaker or consultation fees from Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer Pharma, Abbott, and W.L. Gore and Associates. Dr Kägi has received modest honoraria for travel and advisory board from Bayer, Boehringer Ingelheim, and Zambon and a research grant from the Swiss Heart Foundation, Swiss Parkinson Foundation, Swiss National Science Foundation. Dr Leker has received modest speaker honoraria from Boehringer Ingelheim and Abbott. Dr Zedde received travel or speaker honoraria from Takeda, Daiichi Sankyo, Abbott, Sanofi-Genzyme. Dr Pad-jen reports travel or speaker honoraria from Boehringer Ingelheim and Pfizer and honoraria from scientific advisory board from Medtronic. Dr Cereda has received modest honoraria for scientific advisory board from Bayer, Boehringer Ingelheim, and iSchemaview; Research grants from the Swiss Heart Foundation. Dr Bonati has received grants from the Swiss National Science Foundation (PBBSB-116873, 33CM30-124119, 32003B-156658; Berne, Switzerland), the University of Basel (Basel, Switzerland), the Swiss Heart Foundation (Berne, Switzerland), and the Stif-tung zur Förderung der gastroenterologischen und allgemeinen klinischen Forsc-hung sowie der medizinischen Bildauswertung (Basel, Switzerland). In addition, he has received an unrestricted research grant from AstraZeneca, and consultancy or advisory board fees or speaker’s honoraria from Amgen, Bayer, Bristol-Myers Squibb, Claret Medical, and InnovHeart, and travel grants from AstraZeneca and Bayer. Dr Fischer has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, and Medtronic; furthermore, he is a consultant for Medtronic, Stryker, and CSL Behring. Dr Scheitz reports speaker fees from Bristol-Myers Squibb, and received research funding from the Corona Foundation, outside the submitted work. Dr Wegener received research funds from the Swiss National Science Foundation, the UZH Clinical Research Priority Program (CRPP) stroke, the Swiss Heart Foundation, Boehringer-Ingelheim, a speaker honorarium from Amgen, and a consultancy fee from Bayer. Dr Michel has received through his institution research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, and the ERISTA program (Pfizer/Bristol-Myers Squibb [BMS]) and consulting fees from Medtronic. All this support goes to his institution and is used for stroke education and research. Dr Ringleb reports personal fees from Boehringer Ingelheim, Lecture Fee, personal fees from Bayer, Lecture Fee, personal fees from Daiichi Sankyo, Lecture Fee, and personal fees from Pfizer, Lecture Fee outside the submitted work. Dr Cordonnier participated in symposia organized by Boehringer Ingelheim and Pfizer and advisory board by BMS (honoraria paid to Adrinord); drug trials with Boehringer Ingelheim, Servier, AstraZen-eca, Biogen (honoraria paid to the hospital); she is vice-president of the European Stroke Organisation (unpaid), member of Data and Safety Monitoring Boards for institutional trials (ATTEST 2 [Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis], United Kingdom; FIV-HeMA [FIVHeMA: Intraventricular Fibrinolysis Versus External Ventricular Drainage Alone in Aneurysmal Subarachnoid Hemorrhage: A Randomized Controlled Trial], France; unpaid); and she received research support from the French Ministry of Health (A3ICH trial [Avoiding Anticoagulation After IntraCerebral Haemorrhage]). Dr Arnold reports grants from Swiss Heart Foundation, personal fees from Bayer, personal fees from Medtronic, personal fees from Covidien, personal fees from Amgen, personal fees from Nestle Health Sciences, personal fees from BMS, and personal fees from Daiichi Sankyo during the conduct of the study; grants from Swiss National Science Foundation outside the submitted work. Dr has received funding from the Dutch heart foundation for acute stroke intervention trials in the Collaboration for New Trials in Stroke (CONTRAST) consortium. Dr Engelter has received funding for travel or speaker honoraria from Bayer Boehringer Ingelheim, and Daiichi Sankyo. He has served on scientific advisory boards for Bayer, Boehringer Ingelheim, BMS/Pfizer, MindMaze, and on the editorial board of Stroke. He has received an educational grant from Pfizer and research support from the Science Funds (Wissenschaftsfonds) of the University Hospital Basel, the University Basel, the Swiss Heart Foundation, and the Swiss National Science Foundation. Dr Gensicke has received research support from the Swiss National Science Foundation, advisory board honoraria from Daiichi Sankyo, and funding for travel from BMS/Pfizer. The other authors report no conflicts. Publisher Copyright: © 2021 American Heart Association, Inc. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND AND PURPOSE: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. METHODS: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). RESULTS: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. CONCLUSIONS: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers. GRAPHIC ABSTRACT: An online graphic abstract is available for this article.
AB - BACKGROUND AND PURPOSE: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. METHODS: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). RESULTS: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. CONCLUSIONS: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers. GRAPHIC ABSTRACT: An online graphic abstract is available for this article.
KW - COVID-19
KW - Intracranial hemorrhage
KW - Ischemic stroke
KW - Quality of care
KW - Reperfusion
UR - http://www.scopus.com/inward/record.url?scp=85105017779&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.120.032176
DO - https://doi.org/10.1161/STROKEAHA.120.032176
M3 - Article
C2 - 33793320
SN - 0039-2499
VL - 52
SP - 1693
EP - 1701
JO - Stroke
JF - Stroke
IS - 5
ER -