1. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results
- Author
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Ghoreishi, A, Arsang-Jang, S, Sabaa-Ayoun, Z, Yassi, N, Sylaja, PN, Akbari, Y, Divani, AA, Biller, J, Thanh, P, Steinwender, S, Silver, B, Zand, R, Bin Basri, H, Iqbal, OM, Ranta, A, Ruland, S, Macri, E, Ma, H, Nguyen, TN, Abootalebi, S, Gupta, A, Alet, M, Lattanzi, S, Desai, M, Gagliardi, RJ, Girotra, T, Inoue, M, Yoshimoto, T, Isaac, CF, Mayer, SA, Morovatdar, N, Nilanont, Y, Nobleza, COS, Saber, H, Kamenova, S, Kondybayeva, A, Krupinski, J, Siegler, JE, Stranges, S, Torbey, MT, Yorio, D, Zurru, MC, Rubinos, CA, Shahripour, RB, Borhani-Haghighi, A, Di Napoli, M, Azarpazhooh, MR, Ghoreishi, A, Arsang-Jang, S, Sabaa-Ayoun, Z, Yassi, N, Sylaja, PN, Akbari, Y, Divani, AA, Biller, J, Thanh, P, Steinwender, S, Silver, B, Zand, R, Bin Basri, H, Iqbal, OM, Ranta, A, Ruland, S, Macri, E, Ma, H, Nguyen, TN, Abootalebi, S, Gupta, A, Alet, M, Lattanzi, S, Desai, M, Gagliardi, RJ, Girotra, T, Inoue, M, Yoshimoto, T, Isaac, CF, Mayer, SA, Morovatdar, N, Nilanont, Y, Nobleza, COS, Saber, H, Kamenova, S, Kondybayeva, A, Krupinski, J, Siegler, JE, Stranges, S, Torbey, MT, Yorio, D, Zurru, MC, Rubinos, CA, Shahripour, RB, Borhani-Haghighi, A, Di Napoli, M, and Azarpazhooh, MR
- Abstract
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 admissio
- Published
- 2020