A full year of the COVID-19 pandemic with two infection waves and its impact on ischemic stroke patient care in Germany

Abstract

Background and purpose: Many countries worldwide, including Germany, reported that the first wave of the coronavirus disease 2019 (COVID-19) pandemic in early 2020 influenced the care of acute ischemic stroke (AIS) patients, but data are lacking for further pandemic wave periods.

Methods: We conducted a nationwide, retrospective, cross-sectional study of all hospitalized patients with the main diagnosis of AIS in 2019 and 2020. Primary outcomes were the number of hospitalizations for AIS, the application of stroke unit care, intravenous thrombolysis (IVT), and mechanical thrombectomy (MT), as well as the in-hospital mortality during the different pandemic periods in 2020 compared to the corresponding periods in 2019. Secondarily, we analyzed differences in outcomes between patients with and without concurrent COVID-19.

Results: We included 429,841 cases with AIS, of which 1268 had concurrent COVID-19. Hospitalizations for AIS declined during both pandemic wave periods in 2020 (first wave: -10.9%, second wave: -4.6%). MT rates were consistently higher throughout 2020 compared to 2019, whereas the IVT rate dropped during the second wave period (16.0% vs. 17.0%, p < 0.001). AIS patients with concurrent COVID-19 frequently received recanalization treatments, with an overall MT rate of 8.4% and IVT rate of 15.9%. The in-hospital mortality was high (22.8% vs. 7.5% in noninfected AIS patients, p < 0.001).

Conclusions: These findings demonstrate a smaller decline in hospitalizations for AIS in the more severe second wave of the COVID-19 pandemic. AIS patients with and without concurrent COVID-19 who did seek acute care continued to receive recanalization treatments in Germany.

Keywords: COVID-19; Germany; stroke; thrombectomy; thrombolysis.

FIGURE 1

Relative change in acute ischemic stroke (AIS) patient hospitalizations during 2020. The relative change in AIS patient hospitalizations versus the prior year at a specific time point is displayed by the blue line. The cumulative number of hospitalized COVID‐19 patients at a particular time point is given by the red line

FIGURE 2

Log odds ratio of primary outcomes stratified by the different pandemic periods. Log odds ratio > 0 indicates a higher likelihood for patients during 2020. CI, confidence interval; IVT, intravenous thrombolysis; MT, mechanical thrombectomy; SUC, stroke unit care

FIGURE 3

Log odds ratio of outcomes according to the presence of concurrent COVID‐19. Log odds ratio > 0 indicates a higher likelihood for AIS patients with concurrent COVID‐19. AIS, acute ischemic stroke; CI, confidence interval; IVT, intravenous thrombolysis; MT, mechanical thrombectomy; SUC, stroke unit care