Stroke mortality increased during the first COVID-19 lockdown in the UK compared with the three previous years, a new registry-based cohort study has found.
In an article, published in Stroke, researchers from King’s, Guy’s and St Thomas’ NHS Foundation and the Sentinel Stroke National Audit Programme (SSNAP) analysed data on 184,017 patients admitted with confirmed stroke to 114 hospital trusts in England, Wales and Northern Ireland, between 1 October 2019 and 30 April 2020, and equivalent periods in the three prior years.
Starting from the third week of February 2020, there was an increase in seven-day in-patient case fatality from 6.9 per cent to 9.4 per cent (P<.001), compared with the same period in the three previous years.
This was significantly higher in stroke patients with confirmed or suspected COVID-19, at 22.0 per cent and 21.9 per cent (adjusted rate ratio, 1.41 [95% CI, 1.11-1.80]), respectively, compared with 7.3 per cent for patients with negative/unknown COVID-19 status.
During the first lockdown stroke admissions remained stable until the second week of February 2020 when there was a steep decline. Between 23 March and 30 April 2020, there was a 12 per cent reduction in stroke admissions compared with the same period in the three previous years (6923 vs 7902). Admissions fell more for ischaemic than haemorrhagic stroke, for older patients (over 65 years), and for patients with less severe strokes.
No change was found in the proportion of patients discharged from hospital with good outcomes (modified Rankin Scale score, ≤2; 48% vs 48%), however.
Quality of care was preserved for all measures and in some areas improved during lockdown, such as access to stroke unit care, speed of screening for dysphagia and access to rehabilitation therapies.
Assuming that the true incidence of acute stroke did not change markedly during the pandemic, hospital avoidance may have created a cohort of untreated stroke patients at risk of poorer outcomes or recurrent events, the authors suggested.
