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McCandless MG, Powers AY, Baker KE, Strickland AE. Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States. World Neurosurg 2024; 185:e620-e630. [PMID: 38403013 DOI: 10.1016/j.wneu.2024.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality in the United States among older adults. However, the impact of demographic and geographic risk factors remains ambiguous. A clear understanding of these associations and updated trends in stroke mortality can influence health policies and interventions. METHODS This study characterizes stroke mortality among older adults (age ≥55) in the US from January 1999 to December 2020, sourcing data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. Segmented regression was used to analyze trends in crude mortality rate and age-adjusted mortality rate (AAMR) per 100,000 individuals stratified by stroke subcategory, sex, ethnicity, urbanization, and state. RESULTS A total of 3,691,305 stroke deaths occurred in older adults in the US between 1999 and 2020 (AAMR = 233.3), with an overall decrease in AAMR during these years. The highest mortality rates were seen in nonspecified stroke (AAMR = 173.5), those 85 or older (crude mortality rate1276.7), men (AAMR = 239.2), non-Hispanic African American adults (AAMR = 319.0), and noncore populations (AAMR = 276.1). Stroke mortality decreased in all states from 1999 to 2019 with the greatest and least decreases seen in California (-61.9%) and Mississippi (-35.0%), respectively. The coronavirus pandemic pandemic saw increased stroke deaths in most groups. CONCLUSIONS While there's a decline in stroke-related deaths among US older adults, outcome disparities remain across demographic and geographic sectors. The surge in stroke deaths during coronavirus pandemic reaffirms the need for policies that address these disparities.
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Affiliation(s)
- Martin G McCandless
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA; Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | - Andrew Y Powers
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E Baker
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Allison E Strickland
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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2
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Pulido J, Barrio G, Donat M, Politi J, Moreno A, Cea-Soriano L, Guerras JM, Huertas L, Mateo-Urdiales A, Ronda E, Martínez D, Lostao L, Belza MJ, Regidor E. Excess Mortality During 2020 in Spain: The Most Affected Population, Age, and Educational Group by the COVID-19 Pandemic. Disaster Med Public Health Prep 2024; 18:e27. [PMID: 38372080 DOI: 10.1017/dmp.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education. METHODS An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison. RESULTS All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people. CONCLUSION Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
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Affiliation(s)
- José Pulido
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gregorio Barrio
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Donat
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Julieta Politi
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Moreno
- Department of Sociology, Universidad Pública de Navarra, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Huertas
- Instituto Valenciano de Estadística, Valencia, Spain
- National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elena Ronda
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain
| | - David Martínez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Universidad Pública de Navarra, Spain
| | - María José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Regidor
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Weinberger DM, Bhaskaran K, Korves C, Lucas BP, Columbo JA, Vashi A, Davies L, Justice AC, Rentsch CT. Excess mortality in US Veterans during the COVID-19 pandemic: an individual-level cohort study. Int J Epidemiol 2023; 52:1725-1734. [PMID: 37802889 PMCID: PMC10749763 DOI: 10.1093/ije/dyad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Most analyses of excess mortality during the COVID-19 pandemic have employed aggregate data. Individual-level data from the largest integrated healthcare system in the US may enhance understanding of excess mortality. METHODS We performed an observational cohort study following patients receiving care from the Department of Veterans Affairs (VA) between 1 March 2018 and 28 February 2022. We estimated excess mortality on an absolute scale (i.e. excess mortality rates, number of excess deaths) and a relative scale by measuring the hazard ratio (HR) for mortality comparing pandemic and pre-pandemic periods, overall and within demographic and clinical subgroups. Comorbidity burden and frailty were measured using the Charlson Comorbidity Index and Veterans Aging Cohort Study Index, respectively. RESULTS Of 5 905 747 patients, the median age was 65.8 years and 91% were men. Overall, the excess mortality rate was 10.0 deaths/1000 person-years (PY), with a total of 103 164 excess deaths and pandemic HR of 1.25 (95% CI 1.25-1.26). Excess mortality rates were highest among the most frail patients (52.0/1000 PY) and those with the highest comorbidity burden (16.3/1000 PY). However, the largest relative mortality increases were observed among the least frail (HR 1.31, 95% CI 1.30-1.32) and those with the lowest comorbidity burden (HR 1.44, 95% CI 1.43-1.46). CONCLUSIONS Individual-level data offered crucial clinical and operational insights into US excess mortality patterns during the COVID-19 pandemic. Notable differences emerged among clinical risk groups, emphasizing the need for reporting excess mortality in both absolute and relative terms to inform resource allocation in future outbreaks.
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Affiliation(s)
- Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline Korves
- Department of Veterans Affairs Medical Center, Clinical Epidemiology Program, White River Junction, VT, USA
| | - Brian P Lucas
- Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jesse A Columbo
- Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Anita Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Louise Davies
- Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, VT, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Surgery—Otolaryngology Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Amy C Justice
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
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Na SK, Kim JH, Lee WY, Oh MR. Impact of the COVID-19 Pandemic on Admission and Mortality Among Patients With Severe Emergency Diseases at Emergency Departments in Korea in 2020: Registry Data From the National Emergency Department Information System. J Korean Med Sci 2023; 38:e243. [PMID: 37527913 PMCID: PMC10396429 DOI: 10.3346/jkms.2023.38.e243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/12/2023] [Indexed: 08/03/2023] Open
Abstract
We aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on admissions of patients with acute myocardial infarction, stroke, and severe trauma, and their excess mortality in emergency departments (EDs) in South Korea using registry data from the National Emergency Department Information System (NEDIS) for patients attending EDs of regional and local emergency medical centers. During the outbreak period of 2020, there were 350,698 ED visits, which was lower than the total in 2019 (392,627 visits). Multiple logistic regression revealed that, compared with 2019, there was significantly higher ED mortality rate during the COVID-19 outbreak in 2020 (adjusted odds ratio, 1.10; 95% confidence interval, 1.07-1.13). This finding implies that during the early outbreak period, people might have avoided seeking medical care even for acute and life-threatening conditions, or transfer times at the scene to the hospital arrival were delayed, or treatment for the patients in EDs were delayed.
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Affiliation(s)
- Sun Kyoung Na
- Department of Healthcare, Graduate School of Nursing & Health Professions, Chung-Ang University, Seoul, Korea
- National Emergency Medical Center of National Medical Center, Seoul, Korea
| | - Jeung-Hee Kim
- Division of Chronic Disease Investigation, Capital Regional Center for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Seoul, Korea
- Department of Food and Resource Economics, College of Life Science and Biotechnology, Korea University Graduate School, Seoul, Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
| | - Mi Ra Oh
- National Emergency Medical Center of National Medical Center, Seoul, Korea
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De Luca L, D'Errigo P, Rosato S, Badoni G, Giordani B, Mureddu GF, Tavilla A, Seccareccia F, Baglio G. Impact of COVID-19 Diagnosis on Mortality in Patients with Ischemic Stroke Admitted during the 2020 Pandemic in Italy. J Clin Med 2023; 12:4560. [PMID: 37510675 PMCID: PMC10380878 DOI: 10.3390/jcm12144560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
AIMS The impact of the COVID-19 pandemic on the event rate of patients with ischemic stroke has been poorly investigated. We sought to evaluate the impact of the COVID-19 infection on mortality in patients with ischemic stroke admitted during the 2020 pandemic in Italy. METHODS We analyzed a nationwide, comprehensive, and universal administrative database of patients who were admitted for ischemic stroke during and after the national lockdown for the COVID-19 infection in 2020, and the equivalent periods over the previous 5 years in Italy. The 2020 observed hospitalization and mortality rates of stroke patients with and without COVID-19 infection were compared with the expected rates, in accordance with the trend of the previous 5 years. RESULTS During the period of observation, 300,890 hospitalizations for ischemic stroke occurred in Italy. In 2020, 41,302 stroke patients (1102 with concomitant COVID-19 infection) were admitted at 771 centers. The rate of admissions for ischemic stroke during the 2020 pandemic was markedly reduced compared with previous years (percentage change vs. 2015: -23.5). Based on the 5 year trend, the 2020 expected 30 day and 1 year mortality rates were 9.8% and 23.9%, respectively, and the observed incidence of death rates were 12.2% and 26.7%, respectively (both p < 0.001). After multiple corrections, higher rates of mortality were observed among patients admitted for stroke with a concomitant COVID-19 diagnosis. CONCLUSIONS During the COVID-19 pandemic in 2020 in Italy, the rate of hospitalizations for ischemic stroke was dramatically reduced, although both the 30 day and 1 year mortality rates increased compared with the previous 5 year trend.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, 00152 Rome, Italy
- Faculty of Medicine and Dentistry, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Barbara Giordani
- Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy
| | | | - Andrea Tavilla
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, 00161 Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy
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6
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Weinberger DM, Bhaskaran K, Korves C, Lucas BP, Columbo JA, Vashi A, Davies L, Justice AC, Rentsch CT. Absolute and relative excess mortality across demographic and clinical subgroups during the COVID-19 pandemic: an individual-level cohort study from a nationwide healthcare system of US Veterans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.12.23289900. [PMID: 37293086 PMCID: PMC10246058 DOI: 10.1101/2023.05.12.23289900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Most analyses of excess mortality during the COVID-19 pandemic have employed aggregate data. Individual-level data from the largest integrated healthcare system in the US may enhance understanding of excess mortality. Methods We performed an observational cohort study following patients receiving care from the Department of Veterans Affairs (VA) between 1 March 2018 and 28 February 2022. We estimated excess mortality on an absolute scale (i.e., excess mortality rates, number of excess deaths), and a relative scale by measuring the hazard ratio (HR) for mortality comparing pandemic and pre-pandemic periods, overall, and within demographic and clinical subgroups. Comorbidity burden and frailty were measured using the Charlson Comorbidity Index and Veterans Aging Cohort Study Index, respectively. Results Of 5,905,747 patients, median age was 65.8 years and 91% were men. Overall, the excess mortality rate was 10.0 deaths/1000 person-years (PY), with a total of 103,164 excess deaths and pandemic HR of 1.25 (95% CI 1.25-1.26). Excess mortality rates were highest among the most frail patients (52.0/1000 PY) and those with the highest comorbidity burden (16.3/1000 PY). However, the largest relative mortality increases were observed among the least frail (HR 1.31, 95% CI 1.30-1.32) and those with the lowest comorbidity burden (HR 1.44, 95% CI 1.43-1.46). Conclusions Individual-level data offered crucial clinical and operational insights into US excess mortality patterns during the COVID-19 pandemic. Notable differences emerged among clinical risk groups, emphasising the need for reporting excess mortality in both absolute and relative terms to inform resource allocation in future outbreaks.
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Affiliation(s)
- Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, US
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, US
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline Korves
- Clinical Epidemiology Program, Department of Veterans Affairs Medical Center, White River Junction, VT
| | - Brian P. Lucas
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, US
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, US
| | - Jesse A. Columbo
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, US
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, US
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, US
| | - Anita Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, US
- Department of Emergency Medicine, University of California, San Francisco, CA, US
| | - Louise Davies
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, US
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, US
- Department of Surgery - Otolaryngology Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, US
| | - Amy C. Justice
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, US
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
- VA Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, US
| | - Christopher T. Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
- VA Connecticut Healthcare System, Department of Veterans Affairs, West Haven, CT, US
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Kurtz P, Bastos LSL, Zampieri FG, de Freitas GR, Bozza FA, Soares M, Salluh JIF. Trends in Intensive Care Admissions and Outcomes of Stroke Patients Over 10 Years in Brazil: Impact of the COVID-19 Pandemic. Chest 2023; 163:543-553. [PMID: 36347322 PMCID: PMC9636603 DOI: 10.1016/j.chest.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic affected stroke care worldwide. Data from low- and middle-income countries are limited. RESEARCH QUESTION What was the impact of the pandemic in ICU admissions and outcomes of patients with stroke, in comparison with trends over the last 10 years? STUDY DESIGN AND METHODS Retrospective cohort study including prospectively collected data from 165 ICUs in Brazil between 2011 and 2020. We analyzed clinical characteristics and mortality over a period of 10 years and evaluated the impact of the pandemic on stroke outcomes, using the following approach: analyses of admissions for ischemic and hemorrhagic strokes and trends in in-hospital mortality over 10 years; analysis of variable life-adjusted display (VLAD) during 2020; and a mixed-effects multivariable logistic regression model. RESULTS A total of 17,115 stroke admissions were analyzed, from which 13,634 were ischemic and 3,481 were hemorrhagic. In-hospital mortality was lower after ischemic stroke as compared with hemorrhagic (9% vs 24%, respectively). Changes in VLAD across epidemiological weeks of 2020 showed that the rise in COVID-19 cases was accompanied by increased mortality, mainly after ischemic stroke. In logistic regression mixed models, mortality was higher in 2020 compared with 2019, 2018, and 2017 in patients with ischemic stroke, namely, in those without altered mental status. In hemorrhagic stroke, the increased mortality in 2020 was observed in patients 50 years of age or younger, as compared with 2019. INTERPRETATION Hospital outcomes of stroke admissions worsened during the COVID-19 pandemic, interrupting a trend of improvements in survival rates over 10 years. This effect was more pronounced during the surge of COVID-19 ICU admissions affecting predominantly patients with ischemic stroke without coma, and young patients with hemorrhagic stroke.
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Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Hospital Copa Star, Rio de Janeiro, RJ, Brazil; Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil.
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando G Zampieri
- Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gabriel R de Freitas
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Department of Neurology, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcio Soares
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
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Lee WE, Woo Park S, Weinberger DM, Olson D, Simonsen L, Grenfell BT, Viboud C. Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022. eLife 2023; 12:77562. [PMID: 36811598 PMCID: PMC9946455 DOI: 10.7554/elife.77562] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 01/15/2023] [Indexed: 02/24/2023] Open
Abstract
Excess mortality studies provide crucial information regarding the health burden of pandemics and other large-scale events. Here, we use time series approaches to separate the direct contribution of SARS-CoV-2 infection on mortality from the indirect consequences of the pandemic in the United States. We estimate excess deaths occurring above a seasonal baseline from March 1, 2020 to January 1, 2022, stratified by week, state, age, and underlying mortality condition (including COVID-19 and respiratory diseases; Alzheimer's disease; cancer; cerebrovascular diseases; diabetes; heart diseases; and external causes, which include suicides, opioid overdoses, and accidents). Over the study period, we estimate an excess of 1,065,200 (95% Confidence Interval (CI) 909,800-1,218,000) all-cause deaths, of which 80% are reflected in official COVID-19 statistics. State-specific excess death estimates are highly correlated with SARS-CoV-2 serology, lending support to our approach. Mortality from 7 of the 8 studied conditions rose during the pandemic, with the exception of cancer. To separate the direct mortality consequences of SARS-CoV-2 infection from the indirect effects of the pandemic, we fit generalized additive models (GAM) to age- state- and cause-specific weekly excess mortality, using covariates representing direct (COVID-19 intensity) and indirect pandemic effects (hospital intensive care unit (ICU) occupancy and measures of interventions stringency). We find that 84% (95% CI 65-94%) of all-cause excess mortality can be statistically attributed to the direct impact of SARS-CoV-2 infection. We also estimate a large direct contribution of SARS-CoV-2 infection (≥67%) on mortality from diabetes, Alzheimer's, heart diseases, and in all-cause mortality among individuals over 65 years. In contrast, indirect effects predominate in mortality from external causes and all-cause mortality among individuals under 44 years, with periods of stricter interventions associated with greater rises in mortality. Overall, on a national scale, the largest consequences of the COVID-19 pandemic are attributable to the direct impact of SARS-CoV-2 infections; yet, the secondary impacts dominate among younger age groups and in mortality from external causes. Further research on the drivers of indirect mortality is warranted as more detailed mortality data from this pandemic becomes available.
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Affiliation(s)
- Wha-Eum Lee
- Department of Ecology and Evolutionary Biology, Princeton UniversityPrincetonUnited States
| | - Sang Woo Park
- Department of Ecology and Evolutionary Biology, Princeton UniversityPrincetonUnited States
| | | | - Donald Olson
- New York City Department of Health and Mental HygieneNew YorkUnited States
| | - Lone Simonsen
- Department of Science and Environment, Roskilde UniversityRoskildeDenmark
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton UniversityPrincetonUnited States
- Princeton School of Public Affairs, Princeton UniversityPrincetonUnited States
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of HealthBethesdaUnited States
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9
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Pilotto A, Custodero C, Palmer K, Sanchez-Garcia EM, Topinkova E, Polidori MC. A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS). Eur Geriatr Med 2023; 14:33-41. [PMID: 36656486 PMCID: PMC9851592 DOI: 10.1007/s41999-022-00740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. METHODS A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. RESULTS Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. CONCLUSION Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Katie Palmer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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10
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Kodsi M, Bhat A. Temporal trends in cardiovascular care: Insights from the COVID-19 pandemic. Front Cardiovasc Med 2022; 9:981023. [PMID: 36426232 PMCID: PMC9680953 DOI: 10.3389/fcvm.2022.981023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/30/2022] [Indexed: 04/12/2024] Open
Abstract
In response to the ongoing COVID-19 pandemic, public health care measures have been implemented to limit spread of the contagion and ensure adequate healthcare resource allocation. Correlating with these measures are observed changes in the incidence and outcomes of cardiovascular conditions in the absence of COVID-19 infection. The pandemic has resulted in a reduction in acute coronary syndrome, heart failure and arrhythmia admissions but with worsened outcomes in those diagnosed with these conditions. This is concerning of an underdiagnosis of cardiovascular diseases during the pandemic. Furthermore, cardiovascular services and investigations have decreased to provide healthcare allocation to COVID-19 related services. This threatens an increasing future prevalence of cardiovascular morbidity in healthcare systems that are still adapting to the challenges of a continuing pandemic. Adaption of virtual training and patient care delivery platforms have been shown to be useful, but adequate resources allocation is needed to ensure effectiveness in vulnerable populations.
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Affiliation(s)
- Matthew Kodsi
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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11
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Sanmarchi F, Esposito F, Adorno E, De Dominicis F, Fantini MP, Golinelli D. The impact of the SARS-CoV-2 pandemic on cause-specific mortality patterns: a systematic literature review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-19. [PMID: 36188447 PMCID: PMC9510758 DOI: 10.1007/s10389-022-01755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022]
Abstract
Background Understanding the effects of the COVID-19 pandemic on cause-specific mortality should be a priority, as this metric allows for a detailed analysis of the true burden of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon. Methods We searched MEDLINE, Scopus, and ProQuest for studies that reported cause-specific mortality during the COVID-19 pandemic, extracting relevant data. Results A total of 2413 articles were retrieved, and after screening 22 were selected for data extraction. Cause-specific mortality results were reported using different units of measurement. The most frequently analyzed cause of death was cardiovascular diseases (n = 16), followed by cancer (n = 14) and diabetes (n = 11). We reported heterogeneous patterns of cause-specific mortality, except for suicide and road accident. Conclusions Evidence on non-COVID-19 cause-specific deaths is not exhaustive. Reliable scientific evidence is needed by policymakers to make the best decisions in an unprecedented and extremely uncertain historical period. We advocate for the urgent need to find an international consensus to define reliable methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01755-7.
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Affiliation(s)
- Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Emanuele Adorno
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco De Dominicis
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
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12
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Widemon RS, Huang S, Capaccione KM, Mitchell RP, Salvatore MM, Lignelli A, Nguyen P. The impact of the COVID-19 pandemic on neuroimaging volume in New York City. Neuroradiol J 2022; 35:713-717. [PMID: 35503042 DOI: 10.1177/19714009221096828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic acutely disrupted all facets of healthcare, with future implications that are expected to resonate for many years. We investigated the effect of the pandemic on neuroimaging volume, hypothesizing that all representative studies would experience a reduction in volume, with those typically performed in the inpatient setting (noncontrast enhanced CT head and CTA head/neck) taking longer to recover to pre-pandemic volumes compared to studies typically performed in the outpatient setting (MR brain with and without and MR lumbar spine without). MATERIALS AND METHODS We retrospectively queried our institution's radiology reporting system to collect weekly data for 1 year following the World Health Organization declaration of a pandemic (11 March 2020-9 March 2021) and compared them to imaging volumes from the previous year (11 March 2019-9 March 2020). We subsequently analyzed quarterly data (e.g., first quarter comparison: 3/11/2020-6/9/2020 was compared to 3/11/2019-6/9/2019). RESULTS All studies experienced decreased volume during the first quarter of the year following onset of the COVID-19 pandemic, with noncontrast enhanced CT head failing to recover to pre-pandemic volumes. CTA head/neck actually surpassed pre-pandemic volume by the second quarter of the year. MRI brain w/wo and MRI lumbar spine without recovered to baseline volume by the second quarter. CONCLUSION Noncontrast enhanced CT head did not recover pre-pandemic imaging volume. CTA head/neck volume initially decreased, however volume increased above pre-pandemic levels during the second quarter; this finding may be attributable to a prothrombotic state in COVID-19 patients.
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Affiliation(s)
- Reginald Scott Widemon
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Sophia Huang
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Kathleen M Capaccione
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Ryan P Mitchell
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Mary M Salvatore
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Angela Lignelli
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Pamela Nguyen
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
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13
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Grad DA, Chereches RM, Strilciuc S, Muresanu D. Scars of stroke care emerge as COVID-19 shifts to an endemic in many countries. J Med Life 2022; 15:589-591. [PMID: 35815080 PMCID: PMC9262269 DOI: 10.25122/jml-2022-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Razvan Mircea Chereches
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Stefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dafin Muresanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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14
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Nawabi NL, Kilgallon JL, Duey AH, Medeiros LJ, Aziz-Sultan MA. Perspective: Patient Apprehensions Prolonged Stroke Presentation During the COVID-19 Pandemic. World Neurosurg 2022; 164:241-242. [PMID: 35691086 PMCID: PMC9126612 DOI: 10.1016/j.wneu.2022.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Akbik F, Yang C, Howard BM, Grossberg JA, Danyluk L, Martin KS, Alawieh A, Rindler RS, Tong FC, Barrow DL, Cawley CM, Samuels OB, Sadan O. Delayed Presentations and Worse Outcomes After Aneurysmal Subarachnoid Hemorrhage in the Early COVID-19 Era. Neurosurgery 2022; 91:66-71. [DOI: 10.1227/neu.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
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Lee WE, Park SW, Weinberger DM, Olson D, Simonsen L, Grenfell BT, Viboud C. Direct and indirect mortality impacts of the COVID-19 pandemic in the US, March 2020-April 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.10.22270721. [PMID: 35194617 PMCID: PMC8863161 DOI: 10.1101/2022.02.10.22270721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Excess mortality studies provide crucial information regarding the health burden of pandemics and other large-scale events. Here, we used time series approaches to separate the direct contribution of SARS-CoV-2 infections on mortality from the indirect consequences of pandemic interventions and behavior changes in the United States. We estimated deaths occurring in excess of seasonal baselines stratified by state, age, week and cause (all causes, COVID-19 and respiratory diseases, Alzheimer's disease, cancer, cerebrovascular disease, diabetes, heart disease, and external causes, including suicides, opioids, accidents) from March 1, 2020 to April 30, 2021. Our estimates of COVID-19 excess deaths were highly correlated with SARS-CoV-2 serology, lending support to our approach. Over the study period, we estimate an excess of 666,000 (95% Confidence Interval (CI) 556000, 774000) all-cause deaths, of which 90% could be attributed to the direct impact of SARS-CoV-2 infection, and 78% were reflected in official COVID-19 statistics. Mortality from all disease conditions rose during the pandemic, except for cancer. The largest direct impacts of the pandemic were seen in mortality from diabetes, Alzheimer's, and heart diseases, and in age groups over 65 years. In contrast, the largest indirect consequences of the pandemic were seen in deaths from external causes, which increased by 45,300 (95% CI 30,800, 59,500) and were statistically linked to the intensity of non-pharmaceutical interventions. Within this category, increases were most pronounced in mortality from accidents and injuries, drug overdoses, and assaults and homicides, while the rate of death from suicides remained stable. Younger age groups suffered the brunt of these indirect effects. Overall, on a national scale, the largest consequences of the COVID-19 pandemic are attributable to the direct impact of SARS-CoV-2 infections; yet, the secondary impacts dominate among younger age groups, in periods of stricter interventions, and in mortality from external causes. Further research on the drivers of indirect mortality is warranted to optimize interventions in future pandemics.
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Affiliation(s)
- Wha-Eum Lee
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA, 08544
| | - Sang Woo Park
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA, 08544
| | | | - Donald Olson
- Department of Health and Mental Hygiene, New York, New York
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Denmark
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, USA, 08544
- Princeton School of Public Affairs, Princeton University, Princeton, USA, 08544
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA. 20892
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König S, Pellissier V, Hohenstein S, Leiner J, Hindricks G, Meier-Hellmann A, Kuhlen R, Bollmann A. A Comparative Analysis of In-Hospital Mortality per Disease Groups in Germany Before and During the COVID-19 Pandemic From 2016 to 2020. JAMA Netw Open 2022; 5:e2148649. [PMID: 35166779 PMCID: PMC8848198 DOI: 10.1001/jamanetworkopen.2021.48649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Throughout the ongoing SARS-CoV-2 pandemic, it has been critical to understand not only the viral disease itself but also its implications for the overall health care system. Reports about excess mortality in this regard have mostly focused on overall death counts during specific pandemic phases. OBJECTIVE To investigate hospitalization rates and compare in-hospital mortality rates with absolute mortality incidences across a broad spectrum of diseases, comparing 2020 data with those of prepandemic years. DESIGN, SETTING, AND PARTICIPANTS Retrospective, cross-sectional, multicentric analysis of administrative data from 5 821 757 inpatients admitted from January 1, 2016, to December 31, 2020, to 87 German Helios primary to tertiary care hospitals. EXPOSURES Exposure to SARS-CoV-2. MAIN OUTCOMES AND MEASURES Administrative data were analyzed from January 1, 2016, to March 31, 2021, as a consecutive sample for all inpatients. Disease groups were defined according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10; German modification) encoded main discharge diagnoses. Incidence rate ratios (IRRs) for hospital admissions and hospital mortality counts, as well as relative mortality risks (RMRs) comparing 2016-2019 with 2020 (exposure to the SARS-CoV-2 pandemic), were calculated with Poisson regression with log-link function. RESULTS Data were examined for 5 821 757 inpatients (mean [SD] age, 56.4 [25.3] years; 51.5% women), including 125 807 in-hospital deaths. Incidence rate ratios for hospital admissions were associated with a significant reduction for all investigated disease groups (IRR, 0.82; 95% CI, 0.79-0.86; P < .001). After adjusting for age, sex, the Elixhauser Comorbidity Index score, and SARS-CoV-2 infections, RMRs were associated with an increase in infectious diseases (RMR, 1.28; 95% CI, 1.21-1.34; P < .001), musculoskeletal diseases (RMR, 1.19; 95% CI, 1.04-1.36; P = .009), and respiratory diseases (RMR, 1.09; 95% CI, 1.05-1.14; P < .001) but not for the total cohort (RMR, 1.00; 95% CI, 0.99-1.02; P = .66). Regarding in-hospital mortality, IRR was associated with an increase within the ICD-10 chapter of respiratory diseases (IRR, 1.28; 95% CI, 1.13-1.46; P < .001) in comparing 2020 with 2016-2019, in contrast to being associated with a reduction in IRRs for the overall cohort and several other subgroups. After exclusion of patients with SARS-CoV-2 infections, IRRs were associated with a reduction in absolute in-hospital mortality for the overall cohort (IRR, 0.78; 95% CI, 0.72-0.84; P < .001) and the subgroup of respiratory diseases (IRR, 0.83; 95% CI, 0.74-0.92; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study of inpatients from a multicentric German database suggests that absolute in-hospital mortality for 2020 across disease groups was not higher compared with previous years. Higher IRRs of in-hospital deaths observed in patients with respiratory diseases were likely associated with individuals with SARS-CoV-2 infections.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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18
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Identifying Risk of Adverse Outcomes in COVID-19 Patients via Artificial Intelligence-Powered Analysis of 12-Lead Intake Electrocardiogram. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 3:62-74. [PMID: 35005676 PMCID: PMC8719367 DOI: 10.1016/j.cvdhj.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Adverse events in COVID-19 are difficult to predict. Risk stratification is encumbered by the need to protect healthcare workers. We hypothesize that artificial intelligence (AI) can help identify subtle signs of myocardial involvement in the 12-lead electrocardiogram (ECG), which could help predict complications. Objective Use intake ECGs from COVID-19 patients to train AI models to predict risk of mortality or major adverse cardiovascular events (MACE). Methods We studied intake ECGs from 1448 COVID-19 patients (60.5% male, aged 63.4 ± 16.9 years). Records were labeled by mortality (death vs discharge) or MACE (no events vs arrhythmic, heart failure [HF], or thromboembolic [TE] events), then used to train AI models; these were compared to conventional regression models developed using demographic and comorbidity data. Results A total of 245 (17.7%) patients died (67.3% male, aged 74.5 ± 14.4 years); 352 (24.4%) experienced at least 1 MACE (119 arrhythmic, 107 HF, 130 TE). AI models predicted mortality and MACE with area under the curve (AUC) values of 0.60 ± 0.05 and 0.55 ± 0.07, respectively; these were comparable to AUC values for conventional models (0.73 ± 0.07 and 0.65 ± 0.10). There were no prominent temporal trends in mortality rate or MACE incidence in our cohort; holdout testing with data from after a cutoff date (June 9, 2020) did not degrade model performance. Conclusion Using intake ECGs alone, our AI models had limited ability to predict hospitalized COVID-19 patients’ risk of mortality or MACE. Our models’ accuracy was comparable to that of conventional models built using more in-depth information, but translation to clinical use would require higher sensitivity and positive predictive value. In the future, we hope that mixed-input AI models utilizing both ECG and clinical data may be developed to enhance predictive accuracy.
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19
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Yu AY, Lee DS, Vyas MV, Porter J, Rashid M, Fang J, Austin PC, Hill MD, Kapral MK. Emergency Department Visits, Care, and Outcome After Stroke and Myocardial Infarction During the COVID-19 Pandemic Phases. CJC Open 2021; 3:1230-1237. [PMID: 34723166 PMCID: PMC8548659 DOI: 10.1016/j.cjco.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background It is not known if initial reductions in hospitalization for stroke and myocardial infarction early during the coronavirus disease–2019 pandemic were followed by subsequent increases. We describe the rates of emergency department visits for stroke and myocardial infarction through the pandemic phases. Methods We used linked administrative data to compare the weekly age- and sex-standardized rates of visits for stroke and myocardial infarction in Ontario, Canada in the first 9 months of 2020 to the mean baseline rates (2015-2019) using rate ratios (RRs) and 95% confidence intervals (CIs). We compared care and outcomes by pandemic phases (pre-pandemic was January-March, lockdown was March-May, early reopening was May-July, and late reopening was July-September). Results We identified 15,682 visits in 2020 for ischemic stroke (59.2%; n = 9279), intracerebral hemorrhage (12.2%; n = 1912), or myocardial infarction (28.6%; n = 4491). The weekly rates for stroke visits in 2020 were lower during the lockdown and early reopening than at baseline (RR 0.76, 95% CI [0.66, 0.87] for the largest weekly decrease). The weekly rates for myocardial infarction visits were lower during the lockdown only (RR 0.61, 95% CI [0.46, 0.77] for the largest weekly decrease), and there was a compensatory increase in visits following reopening. Ischemic stroke 30-day mortality was increased during the lockdown phase (11.5% pre-coronavirus disease; 12.2% during lockdown; 9.2% during early reopening; and 10.6% during late reopening, P = 0.015). Conclusion After an initial reduction in visits for stroke and myocardial infarction, there was a compensatory increase in visits for myocardial infarction. The death rate after ischemic stroke was higher during the lockdown than in other phases.
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Affiliation(s)
- Amy Y.X. Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Corresponding author: Dr Amy Y.X. Yu, Neurologist, Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Office A-455, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada. Tel.: +1-416-480-4866; fax: +1-416-480-5753.
| | - Douglas S. Lee
- ICES, Toronto, Ontario, Canada
- Department of Medicine (Cardiology), University of Toronto–University Health Network, Toronto, Ontario, Canada
| | - Manav V. Vyas
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | | | | | - Michael D. Hill
- Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Moira K. Kapral
- ICES, Toronto, Ontario, Canada
- Department of Medicine (General Internal Medicine), University of Toronto–University Health Network, Toronto, Ontario, Canada
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20
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Morita K, Inokuchi R, Jin X, Ishikawa M, Tamiya N. Patients' impressions of after-hours house-call services during the COVID-19 pandemic in Japan: a questionnaire-based observational study. BMC FAMILY PRACTICE 2021; 22:184. [PMID: 34525973 PMCID: PMC8440727 DOI: 10.1186/s12875-021-01534-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022]
Abstract
Background Access to healthcare has been strongly affected by the coronavirus disease 2019 (COVID-19) pandemic, which has raised concerns about the increased risk of delays in receiving medical care. This study aimed to assess the patients’ impressions of after-hour house-call (AHHC) medical services during the COVID-19 pandemic using a patient questionnaire. Methods This was a cross-sectional observational study of anonymized medical record data and internet-based questionnaires from patients who used AHHC medical services from April 2020 to January 2021. We summarized the patients’ impressions of AHHC medical services during the COVID-19 pandemic stratified by patient characteristics. The questions of the questionnaire were as follows: (i) Did you use the AHHC medical services because you suspected you had COVID-19 infection? (ii) Do you feel that the use of AHHC medical services has helped prevent transmission of COVID-19? (iii) What action would you have taken in the absence of AHHC medical services? Results A total of 1802 patients responded to the questionnaire (response rate: 11.3%). First, 700 (40.8%) of the responders indicated that they had used AHHC medical services because of suspicion of COVID-19. Second, most responders (88.8%) felt that AHHC medical services prevented transmission of COVID-19. Third, 774 (43.0%) of the responders considered that they would have visited an emergency department or called an ambulance if AHHC medical services had not been used. Furthermore, 411 (22.8%) of the responders indicated that they would remain at home or wait until working hours if AHHC medical services were not available despite having a condition that required emergency attention. Conclusions AHHC medical services may be one of the strategies for those who refrain from seeking healthcare services, thus reducing the risk of delayed hospital visits during emergencies. Furthermore, AHHC medical services may also contribute to preventing transmission of COVID-19 by avoiding contact with other patients in the hospital.
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Affiliation(s)
- Kojiro Morita
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ryota Inokuchi
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Xueying Jin
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masatoshi Ishikawa
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nanako Tamiya
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
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Bhatia R, Sylaja PN, Srivastava MVP, Komakula S, Iype T, Parthasarathy R, Khurana D, Pardasani V, Pamidimukkala V, Kumaravelu S, Pandian J, Kushwaha S, Chowdhury D, Gupta S, Rajendran SP, Reddy R, Roy J, Sharma A, Nambiar V, Rai NK, Upadhyay AD, Parkipandla S, Singh MB, Vibha D, Vishnu VY, Rajan R, Gupta A, Pandit AK, Agarwal A, Gaikwad SB, Garg A, Joseph L, Sreedharan SE, Reddy S, Sreela K, Ramachandran D, George GB, Panicker P, Suresh MK, Gupta V, Ray S, Suri V, Ahuja C, Kajal K, Lal V, Singh RK, Oza H, Halani H, Sanivarapu S, Sahonta R, Duggal A, Dixit P, Kulkarni GB, Taallapalli AVR, Parmar M, Chalasani V, Kashyap M, Misra B, Pachipala S, Yogeesh PM, Salunkhe M, Gupta P. Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India. J Neurol Sci 2021; 428:117583. [PMID: 34375915 PMCID: PMC8282445 DOI: 10.1016/j.jns.2021.117583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/02/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
Background As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.
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Affiliation(s)
- Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Snigdha Komakula
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Vijaya Pamidimukkala
- Department of Neurology, Lalitha Super Specialities Hospital Pvt. Ltd, Guntur, India
| | - S Kumaravelu
- Department of Neurology, Ramesh Hospitals, Guntur, India
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behavior and Allied Sciences (IBHAS), New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, Gobind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
| | - Salil Gupta
- Department of Neurology, Command Hospital, Bengaluru, India
| | - Srijithesh P Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Rajshekar Reddy
- Department of Neurology, Max Hospital Saket, New Delhi, India
| | - Jayanta Roy
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | - Arvind Sharma
- Zydus Hospital, BJMC & Civil Hospital, Ahmedabad, India
| | - Vivek Nambiar
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Nirendra Kumar Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sathish Parkipandla
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Awadh Kishore Pandit
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shailesh B Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Leve Joseph
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sapna Erat Sreedharan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Sritheja Reddy
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Krishna Sreela
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Dileep Ramachandran
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - Githin Benoy George
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - Praveen Panicker
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - M K Suresh
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Vipul Gupta
- Department of Neurointerventional Surgery, Artemis Hospital, Gurgaon, India
| | - Sucharita Ray
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Suri
- Department of Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chirag Ahuja
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Harsh Oza
- Department of Neurology, Bombay Hospital, Mumbai, India
| | - Hiral Halani
- Department of Neurology, Bombay Hospital, Mumbai, India
| | | | | | - Ashish Duggal
- Department of Neurology, Gobind Ballabh Pant Institute of Postgraduate Education and Research (GIPMER), New Delhi, India
| | - Prashant Dixit
- Department of Neurology, Command Hospital, Bengaluru, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - A V R Taallapalli
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Mamta Parmar
- Zydus Hospital, BJMC & Civil Hospital, Ahmedabad, India
| | - Vamsi Chalasani
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Manshi Kashyap
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Biswamohan Misra
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sudheer Pachipala
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P M Yogeesh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manish Salunkhe
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pranjal Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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22
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Bass DI, Meyer RM, Barros G, Carroll KT, Walker M, D'Oria M, Levitt MR. The impact of the COVID-19 pandemic on cerebrovascular disease. Semin Vasc Surg 2021; 34:20-27. [PMID: 34144743 PMCID: PMC8136291 DOI: 10.1053/j.semvascsurg.2021.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a systemic disease that affects nearly all organ systems through infection and subsequent dysregulation of the vascular endothelium. One of the most striking phenomena has been a coronavirus disease 2019 (COVID-19)–associated coagulopathy. Given these findings, questions naturally emerged about the prothrombotic impact of COVID-19 on cerebrovascular disease and whether ischemic stroke is a clinical feature specific to COVID-19 pathophysiology. Early reports from China and several sites in the northeastern United States seemed to confirm these suspicions. Since these initial reports, many cohort studies worldwide observed decreased rates of stroke since the start of the pandemic, raising concerns for a broader impact of the pandemic on stroke treatment. In this review, we provide a comprehensive assessment of how the pandemic has affected stroke presentation, epidemiology, treatment, and outcomes to better understand the impact of COVID-19 on cerebrovascular disease. Much evidence suggests that this decline in stroke admissions stems from the global response to the virus, which has made it more difficult for patients to get to the hospital once symptoms start. However, there does not appear to be a demonstrable impact on quality metrics once patients arrive at the hospital. Despite initial concerns, there is insufficient evidence to ascribe a causal relationship specific to the pathogenicity of SARS-CoV-2 on the cerebral vasculature. Nevertheless, when patients infected with SARS-CoV-2 present with stroke, their presentation is likely to be more severe, and they have a markedly higher rate of in-hospital mortality than patients with either acute ischemic stroke or COVID-19 alone.
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Affiliation(s)
- David I Bass
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104
| | - R Michael Meyer
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104
| | - Guilherme Barros
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104
| | - Kate T Carroll
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104
| | - Melanie Walker
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104; Stroke and Applied Neurosciences Center, University of Washington, Seattle, WA
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104; Stroke and Applied Neurosciences Center, University of Washington, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA; Department of Mechanical Engineering, University of Washington, Seattle, WA.
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23
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Rana A, Nguyen TN, Siegler JE. Stroke and neurointervention in the COVID-19 pandemic: a narrative review. Expert Rev Med Devices 2021; 18:523-531. [PMID: 33966557 DOI: 10.1080/17434440.2021.1928495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care.Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic's impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases.Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis.
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Affiliation(s)
- Ameena Rana
- Cooper Medical School of Rowan University, Camden United States
| | - Thanh N Nguyen
- Department of Neurology, Radiology, and Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, United States
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, United States
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24
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Stein LK, Mayman NA, Dhamoon MS, Fifi JT. The emerging association between COVID-19 and acute stroke. Trends Neurosci 2021; 44:527-537. [PMID: 33879319 PMCID: PMC8026270 DOI: 10.1016/j.tins.2021.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/08/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023]
Abstract
Prior to COVID-19, only two human-tropic coronaviruses resulted in epidemics and cerebrovascular disease was rarely reported. Evidence now suggests that 1-6% of hospitalized COVID-19 patients develop stroke. According to some reports, stroke risk is more than sevenfold greater in patients with COVID-19 than influenza. Concerningly, outcomes of COVID-19-related stroke are often worse than in stroke patients without COVID-19 from the same cohorts. In this review, we highlight the emerging association between COVID-19 and stroke and discuss putative pathogenetic mechanisms. Etiology of stroke in COVID-19 patients is likely multifactorial, related to coagulopathy, inflammation, platelet activation, and alterations to the vascular endothelium. Significant work remains to be done to better understand the pathogenesis of COVID-19-related stroke and for designing optimal primary and secondary prevention strategies.
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Affiliation(s)
- Laura K Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi A Mayman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johanna T Fifi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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