The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

Abstract

Background and purpose: The 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.

Methods: This 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.

Results: We 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).

Conclusion: Compared 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.

Keywords: COVID-19; Intracerebral haemorrhage; Ischaemic stroke; Patient-reported health outcomes; Stroke.

Fig. 1

Flow chart of patients included pre- and during the first wave of the COVID-19 pandemic. COVID-19 coronavirus disease-2019, TIA transient ischaemic attack, SAH subarachnoid haemorrhage, NCL North Central London

Fig. 2

Point estimates to the right indicate worse health outcomes for physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles and activities pain interference, and pain intensity. Bold circles show between-group mean change and error bars show 95% confidence intervals of each domain

Fig. 3

Adjusted beta coefficients from multivariable linear regression showing associations of the COVID-19 pandemic with patient-reported health domains. Multivariable linear regression model showing the association between admission to stroke unit during COVID-19 pandemic and the adjusted β coefficients (with 95% confidence intervals and p values) from separate multivariable linear regression models for each patient-reported health outcome score, adjusted for potential confounders and variables selected by p < 0.2 in univariable analyses: (age, sex, stroke type, dementia, heart disease, previous stroke/TIA, admission NIHSS, length of stroke unit stay, discharge mRS, discharge destination, ethnicity, antihypertensive, smoking status, general practitioner visit, proxy responder and time to follow-up)