Acute stroke management units and secondary prevention therapies were accessed by significantly fewer patients around the country during the first wave of the pandemic, a new report reveals, leaving stroke specialists with ‘grave concerns’ about the long-term disability and recovery outcomes of people treated at the time.

Despite Australia’s relatively low rates of COVID-19, analysis of data from the Australian Stroke Clinical Registry (AuSCR) shows that stroke care nationally was negatively impacted by the pandemic.

Data from the registry covered locations that had 91% of Australian COVID-19 cases to the end of June 2020 and researchers compared 8,992 episodes of care during the pandemic to the 9,308 acute stroke patients presenting the year before.

Speaking to the limbic, lead investigator Professor Dominique Cadilhac from the Florey Institute of Neuroscience and Mental Health said treatment in stroke units decreased progressively during the pandemic period.

Fewer patients were discharged to inpatient rehabilitation in the early phases of the pandemic and those that were were being discharged earlier, she said. Many patients were discharged without secondary prevention medications compared to the pre-pandemic period. Professor Cadilhac also pointed out that door-to-needle times were longer during the peak pandemic period (March-April, 2020; 82 min, control: 74 min, p = 0.012).

Reduced access

Meanwhile, in a survey run by the same group, clinical staff from hospitals participating in the registry reported fewer resources available for stroke.

Of the 62 survey responses, about half reported reduced presentations, in particular for mild stroke and almost one in three reported longer time from stroke onset to presentation

One in three staff claimed there had been changes to patient flow and management in the Emergency Department while one in four indicated that their stroke unit had moved and one in 10 had a reduced bed capacity for patients with stroke with over one in four respondents stating that stroke specialist staff had been redeployed to work in other roles within the hospital.

“This meant fewer people were accessing the stroke unit, which isn’t great because we know that people on the stroke unit get the specialist care they should be getting to reduce their risk of death and disability,” says Professor Cadilhac.

For patients that did access stroke units during the pandemic, most had their length of stay shortened compared to the pre-pandemic period.

“It could be that people were missing out on important information on how to prevent a future stroke or had not been provided with sufficient information to understand what had happened to them. They may have also missed out on important rehabilitation and some of the  effects of that we’re not going to know for until we’ve got some follow-up data to look at disability impacts and secondary stroke.”

The group has also completed a second analysis, yet to be published, comparing the care people received if they were discharged into a stroke unit versus the care patients received if they’d been looked after by staff from other departments.

“That’s what has driven down all the quality of care measures – it was the people that weren’t looked after by the specialists in the stroke units. They weren’t given the same quality of care; essentially they weren’t looked after in the same way.”

With a clearer picture of the unintended consequences of pandemic restrictions revealed, Professor Cadilhac says the key message is to not reduce standards of care for people who experience stroke.

“They should all have access to stroke units – and the resources within those stroke units should be maintained by specialists staff who are best able to look after those patients so that we don’t have disability impacts that will affect our community longer term.”

Writing in Frontiers in Neurology the authors concluded: “It is imperative that solutions are identified to maintain appropriate acute stroke care during times of national emergency such as pandemic management. These might include alternate models of providing support to patients immediately after stroke and without comprising access to best-practice in-patient care. As Australia cycles out of the initial phase of the COVID-19 pandemic we will need to ensure there is resilience within the health system to similar events in the future.”