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. 2024 Feb 7:15:1351769.
doi: 10.3389/fneur.2024.1351769. eCollection 2024.

Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis

Andy Lim  1 , Peter M Rothwell  2 , Linxin Li  2 , Shelagh B Coutts  3 , Michael D Hill  3 , Maria Guarino  4 , Valentina Barone  5 , Francesca Rondelli  4 , Timothy Kleinig  6 , Reid Cornell-Farrow  6 , Martin Krause  7 , Miriam Wronski  7 , Shaloo Singhal  1   8 , Henry Ma  1   8 , Thanh G Phan  1   8
Affiliations

Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis

Andy Lim et al. Front Neurol. .

Abstract

Background and aim: Rapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics.

Methods: Relevant services were identified by literature search and contacted. Three years of monthly data were requested - a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model.

Results: Six centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI -1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI -7.8 to 1.9, p = 0.25), IVT (-14.3, 95% CI -36.7, 6.1, p < 0.01), and EVT (0, 95% CI -16.9 to 16.9, p = 0.98) counts. Proportion of ischemic strokes requiring IVT decreased from 13.2 to 11.4% (p < 0.05), but those requiring EVT did not change (16.0 to 16.7%, p = 0.33).

Conclusion: This suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic - delays in seeking treatment in this group could be the target for public health intervention.

Keywords: SARS-CoV-2; TIA; TIA clinic; stroke; time series analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Total monthly counts of (A) TIA, (B) ischemic stroke, (C) EVT, and (D) thrombolysis activity from April 2018 to March 2021 by country.
Figure 2
Figure 2
Pooled monthly counts of (A) TIA, (B) ischemic stroke, (C) EVT, and (D) thrombolysis activity from April 2018 to March 2021. Black, actual data; Red, fitted model.
See this image and copyright information in PMC

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