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Title: Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results
Authors: Abdoreza Ghoreishi
Shahram Arsang-Jang
Ziad Sabaa-Ayoun
Nawaf Yassi
P. N. Sylaja
Yama Akbari
Afshin A. Divani
Jose Biller
Thanh Phan
Sandy Steinwender
Brian Silver
Ramin Zand
Hamidon Bin Basri
Omer M. Iqbal
Annemarei Ranta
Sean Ruland
Elizabeth Macri
Henry Ma
Thanh N. Nguyen
Shahram Abootalebi
Animesh Gupta
Matias Alet
Simona Lattanzi
Masoom Desai
Rubens J. Gagliardi
Tarun Girotra
Manabu Inoue
Takeshi Yoshimoto
Cristian Flavo Isaac
Stephan A. Mayer
Negar Morovatdar
Yongchai Nilanont
Christa O.Hana S. Nobleza
Hamidreza Saber
Saltanat Kamenova
Aida Kondybayeva
Jerzy Krupinski
James E. Siegler
Saverio Stranges
Michel T. Torbey
Diana Yorio
María Cristina Zurrú
Clio Aracelli Rubinos
Reza Bavarsad Shahripour
Afshin Borhani-Haghighi
Mario Di Napoli
M. Reza Azarpazhooh
Vali-e-Asr Hospital, Zanjan University of Medical Sciences (ZUMS)
Clinical Neurology Research Center
Department of Neurosciences
Kazakh National Medical University
Luxembourg Institute of Health
Al Farabi Kazakh National University
British Hospital Montevideo
UNM School of Medicine
Università Politecnica delle Marche
Robarts Research Institute
New York Medical College
University of Oklahoma Health Sciences Center
Loyola University Stritch School of Medicine
Walter and Eliza Hall Institute of Medical Research
Westchester Medical Center
Sree Chitra Tirunal Institute for Medical Sciences and Technology
University of Melbourne
Universiti Putra Malaysia
The University of North Carolina at Chapel Hill
Manchester Metropolitan University
Monash University
Cooper University Hospital
University of Otago
Kokuritsu Junkankibyo Senta
Dalhousie University
Faculty of Medicine, Siriraj Hospital, Mahidol University
Western University
UCI Beckman Laser Institute & Medical Clinic
Wayne State University
Instituto Universitario del Hospital Italiano de Buenos Aires
University of Mississippi Medical Center
Boston Medical Center
Geisinger Medical Center
Mashhad University of Medical Sciences
University of Massachusetts Medical School
School of Medicine, Zanjan University of Medical Sciences (ZUMS)
Santa Casa of Sao Paulo Medical School
Hospital Dr. Arturo Oñativia
SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention
Hospital Universitari Mútua Terrassa
San Camillo de' Lellis District General Hospital
Regional Stroke Prevention
Neurol. Div. Hospitals
Keywords: Medicine
Issue Date: 1-Dec-2020
Citation: Journal of Stroke and Cerebrovascular Diseases. Vol.29, No.12 (2020)
Abstract: © 2020 Elsevier Inc. Background: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. Methods: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. Results: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). Conclusion: In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.
ISSN: 15328511
Appears in Collections:Scopus 2020

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