Worse Outcomes For Acute Ischemic Stroke Patients With COVID-19

Among patients presenting with acute ischemic stroke (AIS), those with COVID-19 had lower odds of discharge and greater odds of in-hospital mortality than those without COVID-19 in an analysis of Get With The Guidelines-Stroke data.

"It is notable that patients with AIS and COVID-19 were found to have similar time from stroke symptom onset to arrival, but were more likely to present with higher stroke severity, have large vessel occlusions, and to have a stroke during hospitalization," Dr. Gregg Fonarow of the University of California Los Angeles told Reuters Health by email.

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"Likely due to the need for personal protective equipment use and other precautions, door-to-CT, door-to-needle, and door-to-endovascular therapy times were all longer in the AIS and COVID-19-positive cohort," he noted. "These findings suggest there is a need to further enhance stroke protocols to provide more timely diagnosis and treatment for patients with AIS to speed care while still protecting healthcare workers from exposure."

"In-hospital outcomes were worse among AIS patients with COVID-19, including higher mortality and increased functional disability," he added, "pointing to the need for additional therapies to reduce COVID-19-related morbidity and mortality in patients hospitalized with AIS."

As reported in Stroke, Using Get With The Guidelines-Stroke, the team studied close to 42,000 patients (median age, 71; about half women) with AIS hospitalized in 458 centers from February-June 2020. About 2.75% were COVID-19-positive.

As Dr. Fonarow indicated, those with AIS/COVID-19 were younger, more likely to be non-Hispanic Black, Hispanic, or Asian, more likely to present with higher National Institutes of Health Stroke Scale scores, and had greater proportions of large vessel occlusions compared to AIS/no COVID-19. They also were more likely to have Medicaid/self-pay/no insurance.

Thrombolysis and thrombectomy rates were similar between the groups. As noted, longer times were seen in the AIS/COVID-19 group for door to computed tomography (median, 55 vs. 35 minutes), door to needle (59 vs. 46), and door to endovascular therapy vs. 90).

In adjusted models, AIS/COVID-19 patients had decreased odds of discharge (odds ratio, 0.65) and increased odds of in-hospital mortality (OR, 4.34).

Regarding patient demographics in the two groups, the authors note, "Similar disparities in care have been observed by others, and are likely a reflection of long-standing systemic social inequities."

Dr. Dhruvil Pandya, an interventional neuroradiologist at Northwestern Medicine Central DuPage Hospital in Illinois, commented in an email to Reuters Health, "There are many layers of disparity, and root causes need to be explored. To start, change has to occur at an individual level followed by community, healthcare, and policy makers."

"In my opinion," said Dr. Pandya, who was not involved in the study, "the first step to change is education and awareness. Each individual should look within him/herself and consciously do what they can to reduce disparity."

"There are many initiatives taking place across the country, like HEADS UP 2021: The Health Equity and Actionable Disparity in Stroke: Understanding and Problem Solving with a goal to bridge major inequities in stroke for the vulnerable and underserved population though science, support, and sustainability," he said.

"For 2021, the goal is to (explore) five major inequities in stroke - racial/ethnic, sex, geographic, socioeconomic, and global," he noted. "It is important for us to educate clinicians about these initiatives, and encourage them to contribute in any way possible."

—Marilynn Larkin

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