Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results
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...
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2020
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my.upm.eprints.859402023-10-31T06:09:19Z http://psasir.upm.edu.my/id/eprint/85940/ Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results Ghoreishi, Abdoreza Arsang-Jang, Shahram Sabaa-Ayoun, Ziad Yassi, Nawaf Sylaja, P. N. Akbari, Yama Divani, Afshin A. Biller, Jose Phan, Thanh Steinwender, Sandy Silver, Brian Zand, Ramin Basri, Hamidon Iqbal, Omer M. Ranta, Annemarei Ruland, Sean Macri, Elizabeth Ma, Henry Nguyen, Thanh N. Abootalebi, Shahram Azarpazhooh, M. Reza 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. Elsevier 2020 Article PeerReviewed Ghoreishi, Abdoreza and Arsang-Jang, Shahram and Sabaa-Ayoun, Ziad and Yassi, Nawaf and Sylaja, P. N. and Akbari, Yama and Divani, Afshin A. and Biller, Jose and Phan, Thanh and Steinwender, Sandy and Silver, Brian and Zand, Ramin and Basri, Hamidon and Iqbal, Omer M. and Ranta, Annemarei and Ruland, Sean and Macri, Elizabeth and Ma, Henry and Nguyen, Thanh N. and Abootalebi, Shahram and Azarpazhooh, M. Reza (2020) Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results. Journal of Stroke & Cerebrovascular Diseases, 29 (12). pp. 1-10. ISSN 1052-3057; ESSN: 1532-8511 https://www.sciencedirect.com/science/article/pii/S1052305720307394?via%3Dihub 10.1016/j.jstrokecerebrovasdis.2020.105321 |
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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. |
| format |
Article |
| author |
Ghoreishi, Abdoreza Arsang-Jang, Shahram Sabaa-Ayoun, Ziad Yassi, Nawaf Sylaja, P. N. Akbari, Yama Divani, Afshin A. Biller, Jose Phan, Thanh Steinwender, Sandy Silver, Brian Zand, Ramin Basri, Hamidon Iqbal, Omer M. Ranta, Annemarei Ruland, Sean Macri, Elizabeth Ma, Henry Nguyen, Thanh N. Abootalebi, Shahram Azarpazhooh, M. Reza |
| spellingShingle |
Ghoreishi, Abdoreza Arsang-Jang, Shahram Sabaa-Ayoun, Ziad Yassi, Nawaf Sylaja, P. N. Akbari, Yama Divani, Afshin A. Biller, Jose Phan, Thanh Steinwender, Sandy Silver, Brian Zand, Ramin Basri, Hamidon Iqbal, Omer M. Ranta, Annemarei Ruland, Sean Macri, Elizabeth Ma, Henry Nguyen, Thanh N. Abootalebi, Shahram Azarpazhooh, M. Reza Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results |
| author_facet |
Ghoreishi, Abdoreza Arsang-Jang, Shahram Sabaa-Ayoun, Ziad Yassi, Nawaf Sylaja, P. N. Akbari, Yama Divani, Afshin A. Biller, Jose Phan, Thanh Steinwender, Sandy Silver, Brian Zand, Ramin Basri, Hamidon Iqbal, Omer M. Ranta, Annemarei Ruland, Sean Macri, Elizabeth Ma, Henry Nguyen, Thanh N. Abootalebi, Shahram Azarpazhooh, M. Reza |
| author_sort |
Ghoreishi, Abdoreza |
| title |
Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results |
| title_short |
Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results |
| title_full |
Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results |
| title_fullStr |
Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results |
| title_full_unstemmed |
Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results |
| title_sort |
stroke care trends during covid-19 pandemic in zanjan province, iran from the cascade initiative: statistical analysis plan and preliminary results |
| publisher |
Elsevier |
| publishDate |
2020 |
| url |
http://psasir.upm.edu.my/id/eprint/85940/ https://www.sciencedirect.com/science/article/pii/S1052305720307394?via%3Dihub |
| _version_ |
1781706764918456320 |
| score |
13.211869 |