Publication:
Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

Issued Date

2020-12-01

Resource Type

Article

ISSN

15328511
10523057

DOI

10.1016/j.jstrokecerebrovasdis.2020.105321

Other identifier(s)

2-s2.0-85092513322

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of Stroke and Cerebrovascular Diseases. Vol.29, No.12 (2020)

Suggested Citation

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 Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results. Journal of Stroke and Cerebrovascular Diseases. Vol.29, No.12 (2020). doi:10.1016/j.jstrokecerebrovasdis.2020.105321 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60026

Research Projects

Organizational Units

Authors

Journal Issue

Thesis

Title

Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

Author(s)

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

Other Contributor(s)

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

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/60026

Collections

Scopus 2020