TY - JOUR
T1 - Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19
T2 - An Analysis From Get With The Guidelines-Stroke
AU - Srivastava, Pratyaksh K.
AU - Zhang, Shuaiqi
AU - Xian, Ying
AU - Xu, Hanzhang
AU - Rutan, Christine
AU - Alger, Heather M.
AU - Walchok, Jason G.
AU - Williams, Joseph H.
AU - De Lemos, James A.
AU - Decker-Palmer, Marquita R.
AU - Alhanti, Brooke
AU - Elkind, Mitchell S.V.
AU - Messé, Steve R.
AU - Smith, Eric E.
AU - Schwamm, Lee H.
AU - Fonarow, Gregg C.
N1 - Funding Information:
This work was sponsored by a research contract from Genentech, Inc—A Member of the Roche Group. The coauthor employed by Genentech (MDP) contributed to the study design, interpretation of data, and writing the report. The decision to submit the study for publication was mutually agreed upon by the authors and the sponsor. The Get With The Guidelines–Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. GWTG-Stroke is sponsored, in part, by Novartis, Boehringer Ingelheim and Eli Lilly Diabetes Alliance, Novo Nordisk, Sanofi, AstraZeneca, Bayer, and Portola Pharmaceuticals.
Funding Information:
C. Rutan, J.G. Walchok, J.H. Williams, and Dr Alger employed by the American Heart Association. Dr Smith reports consulting Bayer, Biogen, Javelin; Associate Editor for Stroke; royalties UpToDate. Dr Fonarow reports Consulting Abbott, Amgen, CHF Solutions, Janssen, Medtronic, Merck, Novartis. Dr de Lemos reports Income DSMB or Steering Committees for Amgen, Regeneron, Eli Lilly, Consulting Jannsen. Dr Schwamm reports consulting Medtronic, LifeImage, Genentech; DSMB for Genentech, Penumbra, Diffusion Pharma; Grant funding from Medtronic, PCORI, NINDS; study drug donation from Genentech. Dr Elkind reports study drug in kind from BMS-Pfizer Alliance for Eliquis, ancillary research funding from Roche for National Institutes of Health-funded trial of stroke prevention; royalties UpToDate for stroke and COVID-19 chapters. American Heart Association officer. Dr Decker-Palmer employed by Genentech, Inc. Dr Messé reports Research funding WL Gore, Novartis, Biogen, Mallinkrodt; Personal compensation for participating in clinical event committees for Yale Cardiovascular Research Group; Co-founder, Neuralert Technologies; royalties UpToDate. S. Zhang and Dr Alhanti employed Duke Clinical Research Institute. Dr Xian reports Research funding to Duke Clinical Research Institute from the American Heart Association and Genentech. The other authors report no conflicts.
Publisher Copyright:
© 2021 American Heart Association, Inc.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background and Purpose: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute stroke care. In this study, we analyze the characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke (AIS) pre-COVID-19 and during COVID-19. Methods: Get With The Guidelines-Stroke is a national registry of adults with stroke in the United States. Using this registry, we identified patients with a diagnosis of AIS before (n=39 113; November 1, 2019-February 3, 2020) and after (n=41 971; February 4, 2020-June 29, 2020) the first reported case of COVID-19 in the registry. Characteristics, treatment patterns, quality metrics, and in-hospital outcomes were compared between the 2 groups. Results: Stroke presentations decreased by an average of 15.3% per week in the during COVID-19 time period when compared with similar months in 2019. Compared with patients with AIS in the pre-COVID-19 era, patients in the COVID-19 time period had similar rates of intravenous alteplase and endovascular therapy, and similar door to computed tomography, door to needle, and door to endovascular therapy times. In adjusted models, inpatient mortality was similar between those presenting with AIS pre-COVID-19 and during COVID-19 (4.8% versus 5.2%; odds ratio, 1.05 [95% CI, 0.97-1.13]). Conclusions: Among hospitals participating in Get With The Guidelines-Stroke, patients presenting with AIS during COVID-19 received, with few exceptions, similar quality care and experienced similar risk-adjusted outcomes when compared with patients with AIS presenting pre-COVID-19. These findings demonstrate that stroke care in the United States remains robust during the COVID-19 pandemic.
AB - Background and Purpose: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute stroke care. In this study, we analyze the characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke (AIS) pre-COVID-19 and during COVID-19. Methods: Get With The Guidelines-Stroke is a national registry of adults with stroke in the United States. Using this registry, we identified patients with a diagnosis of AIS before (n=39 113; November 1, 2019-February 3, 2020) and after (n=41 971; February 4, 2020-June 29, 2020) the first reported case of COVID-19 in the registry. Characteristics, treatment patterns, quality metrics, and in-hospital outcomes were compared between the 2 groups. Results: Stroke presentations decreased by an average of 15.3% per week in the during COVID-19 time period when compared with similar months in 2019. Compared with patients with AIS in the pre-COVID-19 era, patients in the COVID-19 time period had similar rates of intravenous alteplase and endovascular therapy, and similar door to computed tomography, door to needle, and door to endovascular therapy times. In adjusted models, inpatient mortality was similar between those presenting with AIS pre-COVID-19 and during COVID-19 (4.8% versus 5.2%; odds ratio, 1.05 [95% CI, 0.97-1.13]). Conclusions: Among hospitals participating in Get With The Guidelines-Stroke, patients presenting with AIS during COVID-19 received, with few exceptions, similar quality care and experienced similar risk-adjusted outcomes when compared with patients with AIS presenting pre-COVID-19. These findings demonstrate that stroke care in the United States remains robust during the COVID-19 pandemic.
KW - coronavirus
KW - inpatient
KW - ischemic stroke
KW - pandemics
KW - tomography
UR - http://www.scopus.com/inward/record.url?scp=85116580610&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85116580610&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.034414
DO - 10.1161/STROKEAHA.120.034414
M3 - Article
C2 - 34192897
AN - SCOPUS:85116580610
SN - 0039-2499
VL - 52
SP - 3225
EP - 3232
JO - Stroke
JF - Stroke
IS - 10
ER -