Abstract
Background and purposeThe COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke.MethodsThis retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March–16th May 2018 (pre-COVID-19 pandemic); and 16th March–16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System–29 (PROMIS-29 version 2.0) at 30 days after stroke.ResultsWe included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001).ConclusionCompared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health.
Highlights
The ongoing global COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARsCoV-2), first documented in Wuhan, China [1], has spreadMembers of the "the Stroke Investigation in North and Central London (SIGNaL) collaborators" are listed in Acknowledgements section.to more than 200 countries and resulted in over 4.6 million deaths worldwide [2]
Compared with the pre-pandemic cohort, the cohort studied during the pandemic had: more severe strokes; a higher proportion of patients from Black or Asian ethnic groups (24.2% vs 12.3% and 26.3% vs 11.3%, respectively); more severe disability at hospital discharge; a longer HASU stay (4 vs 3 days); a higher proportion of patients receiving early supported discharge (53.7% vs 34%); and a higher proportion of patients who did not see a general practitioner after discharge (41% vs 19.1%)
Our data clearly show that stroke survivors treated during the COVID-19 pandemic reported substantially worse patient-reported health outcomes at 30 day follow-up, even after adjusting for potential confounding factors
Summary
The ongoing global COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARsCoV-2), first documented in Wuhan, China [1], has spreadMembers of the "the SIGNaL collaborators" are listed in Acknowledgements section.to more than 200 countries and resulted in over 4.6 million deaths worldwide [2]. Journal of Neurology avirus-16-march-2020) [3] These measures included: closure of educational institutions, workplaces and places of worship; bans on public events and international travel; movement restrictions; limiting physical interactions (including visiting family and friends); working from home where possible; one form of exercise a day; and only contacting doctors or general practitioners via telephone or video call. These measures included: closure of educational institutions, workplaces and places of worship; bans on public events and international travel; movement restrictions; limiting physical interactions (including visiting family and friends); working from home where possible; one form of exercise a day; and only contacting doctors or general practitioners via telephone or video call3 Overnight these measures transformed societal behaviour, inter-community links, and social and clinical care services; this has led to concerns about delays in clinical treatments and social support with increased regional disparities in health outcomes [4]. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health
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