Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19

Abstract

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.