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. 2020 Dec;51(12):3746-3750.
doi: 10.1161/STROKEAHA.120.031293. Epub 2020 Oct 16.

Reduced Admissions for Cerebrovascular Events During COVID-19 Outbreak in Italy

Simona Sacco  1 , Stefano Ricci  2 , Raffaele Ornello  1 , Paolo Eusebi  3 , Luca Petraglia  4 , Danilo Toni  4 ; Italian Stroke Organization
Collaborators, Affiliations

Reduced Admissions for Cerebrovascular Events During COVID-19 Outbreak in Italy

Simona Sacco et al. Stroke. 2020 Dec.

Abstract

Background and purpose: We aimed to investigate the rate of hospital admissions for cerebrovascular events and of revascularization treatments for acute ischemic stroke in Italy during the coronavirus disease 2019 (COVID-19) outbreak.

Methods: The Italian Stroke Organization performed a multicenter study involving 93 Italian Stroke Units. We collected information on hospital admissions for cerebrovascular events from March 1 to March 31, 2020 (study period), and from March 1 to March 31, 2019 (control period).

Results: Ischemic strokes decreased from 2399 in 2019 to 1810 in 2020, with a corresponding hospitalization rate ratio (RR) of 0.75 ([95% CI, 0.71-0.80] P<0.001); intracerebral hemorrhages decreased from 400 to 322 (hospitalization RR, 0.81 [95% CI, 0.69-0.93]; P=0.004), and transient ischemic attacks decreased from 322 to 196 (hospitalization RR, 0.61 [95% CI, 0.51-0.73]; P<0.001). Hospitalizations decreased in Northern, Central, and Southern Italy. Intravenous thrombolyses decreased from 531 (22.1%) in 2019 to 345 in 2020 (19.1%; RR, 0.86 [95% CI, 0.75-0.99]; P=0.032), while primary endovascular procedures increased in Northern Italy (RR, 1.61 [95% CI, 1.13-2.32]; P=0.008). We found no correlation (P=0.517) between the hospitalization RRs for all strokes or transient ischemic attack and COVID-19 incidence in the different areas.

Conclusions: Hospitalizations for stroke or transient ischemic attacks across Italy were reduced during the worst period of the COVID-19 outbreak. Intravenous thrombolytic treatments also decreased, while endovascular treatments remained unchanged and even increased in the area of maximum expression of the outbreak. Limited hospitalization of the less severe patients and delays in hospital admission, due to overcharge of the emergency system by COVID-19 patients, may explain these data.

Keywords: Italy; cerebral hemorrhage; disease outbreaks; incidence; ischemic attack, transient.

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Conflict of interest statement

Dr Ornello reports nonfinancial relationships with Novartis, Allergan, and Teva; Dr Sacco reports personal fees and nonfinancial support from Allergan, Abbott, Eli Lilly, Novartis, and Teva; personal fees from Medscape; and other from Bayer, Pfizer, Medtronic, Starmed, Bristol-Myers Squibb, and Daiichi Sankyo outside the submitted work; Dr Toni reports personal fees for advisory board and speakers’ honoraria from Abbott, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, and Pfizer; Dr Ricci reports nonfinancial support from Bayer. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Hospitalization rate ratios of cerebrovascular events and subtypes in Italy, March 2020 vs March 2019.
Figure 2.
Figure 2.
Rate ratios of procedures for acute ischemic stroke in Italy, March 2020 vs March 2019.
Figure 3.
Figure 3.
Correlation between the hospitalization rate ratio for all strokes or transient ischemic attack (March 2020 vs March 2019) and coronavirus disease 2019 (COVID-19) incidence in mid-March 2020. Each dot represents an Italian Region or Autonomous Province.
See this image and copyright information in PMC

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