Abstract Details

Title Quantifying Changes in Acute Stroke Presentations and Associated Workflow During the COVID-19 Pandemic: A Population-based Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 004

Objective

To understand the effect of the COVID-19 pandemic on the presentation and treatment of acute ischemic stroke.

Background

Pandemics may result in hospital avoidance among patients with emergencies, and the added demands of precautions during stroke codes may exacerbate treatment delays. There is a paucity of population-based data on these phenomena.

Design/Methods

We extracted data from the Quality Improvement and Clinical Research(QuICR) Alberta Stroke Program, a Canadian population-based stroke registry capturing stroke-related data on the entire population of Alberta, Canada. We used linked administrative data to identify all patients hospitalized with stroke pre-COVID-19(1-January-2016 to 27-February-2020) and post-COVID-19 (28-February-2020 to 30-June-2020). We used Poisson regressions to evaluate changes in stroke hospitalizations and use of thrombolysis and endovascular therapy(EVT), adjusted for age, sex, comorbidities, and continuing care needs. We compared proportions receiving treatment using logistic regressions, and compared workflow metrics and stroke severity (National Institutes of Health Stroke Scale, NIHSS) using generalized linear models.

Results

We analyzed 19,531 patients with ischemic stroke pre-COVID-19 versus 1,400 post-COVID-19. Hospitalizations dropped post-COVID-19 (weekly aIRR:0.49,95%CI 0.46-0.52), as did incidence of thrombolysis (aIRR:0.50,0.42-0.59) and EVT (aIRR:0.56,0.44-0.72). However, the proportions of presenting patients receiving thrombolysis and EVT among all ischemic patients were unchanged (thrombolysis 12.9% pre- and post-COVID, aOR:0.86,0.58-1.29; EVT 6.2% pre- vs 6.8% post-COVID, aOR:1.30, 0.91-1.84). Call-to-ambulance-dispatch and call-to-paramedics-on-scene times were prolonged post-COVID-19 (adjusted-coefficient for call-to-paramedics-on-scene:9.05min, 5.41-12.7), and EVT recipients experienced a greater delay in CT-to-groin-puncture and door-to-groin-puncture times (e.g. CT-to-groin-puncture median 53min, IQR 35-79 pre- vs 73min, 44-108 post-COVID; adjusted-coefficient: 15.33min, 95%CI 2.09-28.6). Among treated patients, there were no relevant differences in NIHSS, onset-to-call, door-to-CT, or door-to-needle times.

Conclusions

The pandemic was associated with a halving of presentations for ischemic stroke and use of acute therapies at a population level, and greater pre-hospital and in-hospital workflow delays. Our results may help inform public health messaging and help optimize stroke workflow.

Authors/Disclosures
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary) PRESENTER	Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli-Lilly. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for �鶹��ýӳ�� (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has or had stock in SnapDx.Dr. Ganesh has or had stock in Collavidence Inc.Dr. Ganesh has or had stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Finlay McAlister (University of Alberta)	No disclosure on file
Michael D. Hill, MD (University of Calgary)	Dr. Hill has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boehringer Ingelheim. Dr. Hill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sun Pharma. Dr. Hill has received stock or an ownership interest from Circle Neurovascular.
Eric E. Smith, MD (University of Calgary)	Dr. Smith has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Smith has received publishing royalties from a publication relating to health care. Dr. Smith has received publishing royalties from a publication relating to health care.

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