Intracerebral hemorrhage (ICH) poses a significant health challenge, notably affecting adolescents and young adults (AYAs) aged 15-39 years. Despite advancements in medical technology, the global burden of ICH remains substantial, influenced by lifestyle factors, socioeconomic conditions, and disparities in healthcare access. This study leverages data from the 2021 Global Burden of Disease (GBD) to conduct a comprehensive analysis of ICH trends and burdens at global, regional, and national levels, emphasizing the role of the Social Development Index (SDI).

We utilized data from the GBD 2021 to assess the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) associated with ICH from 1990 to 2021, covering 204 countries and regions. Age-standardized rates were calculated to ensure comparability. Temporal trends were evaluated using Joinpoint regression analysis, and future projections were made using a Bayesian Age-Period-Cohort model.

In 2021, ~246,938 new cases of ICH were reported among the global AYAs population, reflecting a decline in age-standardized incidence rates from 11.85 per 100,000 in 1990 to 8.14 in 2021. Prevalence rates also decreased from 124.44 to 94.58 per 100,000. Mortality rates and DALYs exhibited similar downward trends. Significant regional disparities were observed, with high SDI regions experiencing lower ICH burdens than low SDI regions, highlighting the influence of socioeconomic factors and healthcare access.

While the global burden of ICH among AYAs has declined, significant disparities persist, particularly in regions with lower SDI. To further mitigate the impact of ICH, public health initiatives should focus on enhancing healthcare infrastructure, promoting health education, and addressing socioeconomic inequalities.

To explore the possible latent classifications of pre-hospital delayed intention at high risk of stroke and to analyse the characteristics of different profiles.

A cross-sectional study was conducted in one community in Shanghai, China. Four hundred and seventy individuals at high risk of stroke were recruited, and self-reported questionnaires (including socio-demographic, stroke knowledge, health belief, and pre-hospital delay behaviour intention scale) were distributed between April and June 2023. A latent profile analysis was employed to identify the delay intention clusters, and multinomial logistic regression was utilized to ascertain the factors influencing the latent classes of delay intention. Four hundred and fifty-seven high-risk populations with a response rate of 97.23% were finally enrolled in this study. Four distinct classes were identified: high warning signs-low delay intention (26.3%), low warning signs-low delay intention (17.7%), moderate level of delay intention (37.3%), and high level of delay intention (18.7%). The influencing factors included stroke knowledge, health belief, age, education background, the nearest distance to the medical institution, and household income.

The pre-hospital delay intention among high-risk populations of stroke was classified into four distinct classes. It is crucial for individuals at high risk to remain vigilant towards stroke symptoms and to take prompt action. Health promotion education may be explored as a strategy to bridge the gap between the recognition of stroke symptoms and the low pre-hospital delay intention.

The novel coronavirus disease 2019 (COVID-19) pandemic led to the implementation of wide-ranging institutional infection control protocols. The purpose of this study is to determine the effect of the pandemic on outcomes of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT).

Data were obtained from prospectively collected quality improvement stroke databases at six Canadian comprehensive stroke centres from March 11, 2020 to March 11, 2021. This patient cohort was compared to pre-pandemic patients consecutively treated with EVT from March 11, 2019 to March 10, 2020. The primary outcome is a 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics.

A total of 1329 EVT patients (pre-pandemic n = 666) were included. The initial NIHSS was statistically significantly lower in the pandemic cohort. Other baseline patient characteristics were comparable between the two periods. Median (interquartile range, IQR) time from last seen normal (LSN) to emergency department (ED) (172 (68-316) vs 210 (97-382) min; p = 0.0001), LSN to puncture (235 (160-378) vs 280 (184-475); p < 0.0001), computed tomography (CT) to angiographic table (68 (44-108) vs 84 (57-125) min; p = 0.002), ED to angiographic table (65 (37-96) vs 80 (50-112) min; p = 0.001), CT to recanalization (117 (84-156) vs 130 (89-173) min; p = 0.038) and LSN to recanalization (279 (198-453) vs 327 (219-561) min; p = 0.002) were longer in the pandemic period as compared to the pre-pandemic. There were no significant differences in median time from angiographic table to arterial puncture (13 (8-19) vs 12 (9-16) min; p = 0.70) or arterial puncture to first pass (21 (14-31) vs 20 (14-30) min; p = 0.50). Patients were more likely to have favourable outcomes (mRS at 90 days score of ≤ 2) post-EVT pre-pandemic than pandemic (53% vs 44%; p = 0.02). Furthermore, analysis of the time interval from "LSN to arterial puncture" in relation to functional outcomes showed that the percentage of unfavorable outcomes increased among patients who underwent EVT within 240 minutes. Specifically, the rate of unfavorable outcomes rose from 32.9% to 42.9% (p = 0.37 for intervals under 150 minutes) and from 41.6% to 52.3% (p = 0.15 for intervals between 151 and 240 minutes) when comparing pre-pandemic to pandemic periods. However, the detrimental effect associated with the pandemic was diminished in patients who received EVT beyond 240 mins (p = 1.0).

In this multicenter study involving six Canadian stroke centers, patients exhibited a higher probability of unfavorable long-term functional outcomes following EVT during the pandemic period compared to those in the pre-pandemic cohort, particularly during the first year of the pandemic.

Background/Objectives: Stroke is a leading cause of mortality and disability worldwide, ranking as the second most common cause of death and the third in disability-adjusted life-years lost. Ischaemic stroke, which constitutes the majority of cases, poses significant public health and economic challenges. This study evaluates trends in ischaemic stroke hospitalisations in Italy from 2008 to 2022, focusing on differences before and after the COVID-19 pandemic. Methods: We analysed ischaemic stroke hospitalisations among individuals admitted through emergency services using Italian hospital discharge records from 2008 to 2022. Poisson Inverse Gaussian regression was employed to assess hospitalisation trends, accounting for age, sex, and geographic variations. Results: Among 1,689,844 ischaemic stroke hospitalisations, there was a marked age-related increase, particularly among individuals aged 74 and older, with males consistently showing higher rates. Hospitalisation trends demonstrated a 20% reduction over 15 years, suggesting improvements in stroke prevention and treatment. However, there was a slight increase in rates during the COVID-19 period, despite the overall declining trend, highlighting the potential healthcare challenges experienced during the pandemic. Multivariable analysis confirmed age and male sex as significant risk factors. Conclusions: This study underscores the age-related increase in stroke hospitalisation rates, emphasising the need for targeted prevention strategies for elderly populations. The overall reduction in stroke hospitalisation rates reflects advancements made in healthcare, although the impact of COVID-19 on access to stroke care is evident. Future policies must address the pandemic's effects on stroke care continuity and prioritise interventions tailored to age and sex.

Worldwide, health systems have been challenged by the overwhelming demands of the COVID-19 pandemic. In Ethiopia, maintaining essential health services during the COVID-19 pandemic is critical to preventing severe outcomes and protecting the gains made over the past years in the health sector. This project aims to explore the health system's response to maintaining essential healthcare services in Addis Ababa, Ethiopia.

A total of 60 key informant interviews were conducted by purposively selecting key stakeholders from Federal Ministry of Health, Addis Ababa Regional Health Bureau, Sub-city Health Offices, and frontline healthcare providers. Interviews were transcribed verbatim and coded using Open Code. Thematic analysis was employed to analyze the data.

COVID-19 affected the delivery of essential health services in several ways, namely: decline in health service utilization, fear of infection among healthcare providers, stigma towards healthcare providers, and perceived decrease in quality-of-service provision. However, the health system actors made efforts to sustain services while responding to the pandemic by enacting changes in the service delivery modality. The most significant service delivery changes included repurposing health centers and prolonged prescriptions (multi-month medication dispensing). The primary challenges encountered were burnout of the health workforce and a shortage of personal protective equipment.

COVID-19 has affected the delivery of essential health services in multifaceted ways. System actors have accordingly made efforts to sustain services while responding to the pandemic.

It is common to protect people from air pollution by wearing masks, but how much of its health effect on cardiovascular diseases (CVDs) is unknown. This study aimed to determine whether the mask intervention associated with decrease in stroke morbidity and mortality.

We conducted a retrospective cohort study comprising 7.8 million residents in Weifang, China from 2016 to 2022. The primary outcome was the daily stroke morbidity and mortality. An interrupted time series analysis, adjusting for underlying secular trends, seasonal patterns, air pollution, meteorological factors, health services utilization and road lockdowns, was performed to assess the immediate and gradual changes of stroke morbidity and mortality after the implementation of mask-wearing regulations.

During the study period, 400,245 incident cases and 64,719 deaths of stroke were identified. Findings indicated a 5.5% (95% confidence interval (CI): 0.8%-10.0%) immediate and a 14.3% annual gradual (95% CI: 12.7%-15.8%) reduction were observed in stroke morbidity after the implementation of the regulations, which resulted in an overall reduction of 38.6% (95% CI: 34.1%-43.2%) within 33 months of follow-up. Similarly, there was the gradual decrease in stroke mortality. It resulted in an overall post-intervention decrease of 8.4% (95% CI, 1.6%-15.1%). The subgroup analyses indicated that overall post-regulation reductions in stroke morbidity were observed across all age groups, genders, and subtypes. However, the overall reduction in stroke mortality among male and those with hemorrhagic stroke was not statistically significant.

These findings have implications for policy makers and public health experts seeking to reduce burden of stroke morbidity and mortality at the population level through personal protection measure in regions with severe air pollution.

This study evaluates the sensitivity of major chronic diseases to the collapse of the healthcare system for developing prevention and control strategies under normal and emergency conditions. Data for the years 2018, 2019, and 2020 (coronavirus disease 2019 [COVID-19] pandemic) were curated from the National Disease Mortality Surveillance System, Chinese Center for Disease Control and Prevention for diseases such as cancer, heart disease (HD), cerebrovascular disease (CVD), and chronic obstructive pulmonary disease (COPD). The yearly death rate change for 2018, 2019, and 2020 were calculated. Similarly, expected and observed death cases, 95% confidence intervals, and Z-score were calculated for the year 2020 (COVID-19 pandemic). Furthermore, linear regression analysis was performed to analyze a correlation between the median age of various groups and the mortality rate. The observed death cases for cerebrovascular, heart, and other chronic diseases, were more than the expected death cases (430,007 vs 421,317, 369,684 vs 368,957, and 302,974 vs 300,366) as well as an upper limit of 95% confidence interval. The observed death cases for COPD and cancer are less than the expected death cases (127,786 vs 140,524, 450,346 vs 463,961) and lower limit of the 95% confidence interval. The highest Z-score was noted for cerebrovascular disease (105.14). The disease impact of severity was CVD, other chronic diseases, and HD in descending order. The unexpected decline in deaths was found for COPD and cancers with Z-scores (-166.45 and -116.32). The severity of impact was CVD, other chronic diseases, HD, cancer, and COPD in descending order. The COVID-19 pandemic has also resulted in an increase in deaths of the relatively young population as shown by the difference in rate of slop. The healthcare system collapsed due to prevention, control measures and increased burden of COVID-19 patients, affected chronic disease treatment/management and as a consequence variation in death rates occurs in different chronic diseases. A marked increase in mortality was observed in cerebrovascular disease. The unexpected decline in deaths from COPD and cancers, and increase in deaths of the relatively young population suggests that there may be opportunities for improvement in chronic disease management.

To the best of our knowledge, to date, there is no comprehensive review study that has explored the effects and impacts of the COVID-19 pandemic on emergency medical services (EMS) systems. Therefore, this systematic review will be conducted to investigate the effects of the COVID-19 pandemic on the delivery of pre-hospital emergency care services in EMS agencies. To achieve the study aims, electronic databases such as PubMed, Scopus, Web of Science, and Google Scholar will be searched for related studies. It seems that reviewing the effects of the COVID-19 pandemic on EMS systems, play an important role in identifying and solving the main challenges of EMS in future pandemics.

It is essential to understand the consequences of the COVID-19 pandemic on stroke care, contemplating the potential health and economic consequences of missed diagnoses or treatments. This study examined the pandemic's effects on stroke epidemiology, clinical characteristics, and treatment in a hospital setting, comparing data from March 2020 to February 2021 with the homologous period the previous year. A secondary analysis focused on the state of emergency periods (March 19 to May 2 and November 6 to February 28). The sample included 730 stroke admissions, with 343 during the pandemic. There was a 24.75% reduction in the average daily occupancy rate (p<0.001) and a slight decrease in average daily admissions, especially in June from 132% to 74% (p=0.01). There was a moderate negative correlation between the number of COVID-19 cases and occupancy rates in January (r{s}=-0.422, p=0.01) and February (r{s}=-0.532, p=0.01). Admissions for ischemic stroke decreased by 7.2% (p=0.026), particularly mild events, with a 6.8% decrease in lacunar syndromes (p=0.048). Mechanical thrombectomy (MT) increased by 5.4% (p=0.046), while intravenous thrombolysis (IVT) decreased by 2.8% (p=0.048), especially in severe stroke cases (-21.4%, p=0.001). The pandemic period documented more MT procedures than IVT. Hemorrhagic stroke admissions increased by 6.7% (p=0.01). The analysis suggests a reduction in mild ischemic stroke admissions and fewer patients undergoing IVT for severe strokes during the pandemic. Broader-scale studies are necessary to confirm these findings. Considering the documented decline in diagnosis and treatment, minimizing the impact on stroke care during potential sanitary crises is paramount.

The COVID-19 pandemic had significant impact on global healthcare, including stroke management. Telemedical stroke networks have emerged with positive results for patient outcome in rural areas without stroke expertise. However, telestroke faced enormous on-site challenges during the pandemic. So far, data on performance and clinical outcomes in telestroke settings during the COVID-pandemic are scarce.

We retrospectively analyzed data from stroke patients treated in four spoke hospitals of the Bavarian telestroke network NEVAS in 2020-2021 and 2019 as reference year and compared the 3 years for various parameters. Primary outcome was functional outcome according to the modified Rankin scale (mRS). Secondary outcome parameters included time intervals, periprocedural intracranial hemorrhage rates, and mortality.

In 2019-2021, 2820 patients were treated for acute ischemic stroke with an admission decrease of 10% during the pandemic. Of those, 241 received only IVT and 204 were transferred to our center for MT. Door-to-imaging, door-to-needle, and symptom-onset-to-groin times remained comparable in the 3 years. Complication rates remained at a low level. Good clinical outcome rates (mRS 0-2) at discharge remained stable for all stroke patients (82-84%) and for those treated with IVT (64-77%). Good clinical outcome rates at 3 month follow-up for MT patients declined in 2020 (23% vs. 35% in 2019) but recovered again in 2021 (42%). Mortality rates did not increase for all patient groups analyzed.

Stroke care remained robust during the COVID-pandemic within our network, indicating that well-established telestroke networks can overcome unexpected critical challenges such as a pandemic, guaranteeing best practice stroke care in rural areas.

In response to the COVID-19 pandemic, WHO launched a strategic preparedness and response plan, outlining public health measures to support countries worldwide. Healthcare workers have an increased risk of becoming infected and their behaviour regarding infection prevention and control (IPC) influences infection dynamics. IPC strategies are important across the globe, but even more in low-resource settings where capacities for testing and treatment are limited. Our study aimed to assess and implement COVID-19 pandemic preparedness and response measures in Faranah, Guinea, primarily focusing on healthcare workers' IPC knowledge, attitude and practice (KAP).

The study was conducted between April 2020 and April 2021 assessing IPC pandemic preparedness and response measures such as healthcare workers' KAP, alcohol-based handrub (ABHR) consumption and COVID-19 triaging in the Faranah Regional Hospital and two associated healthcare centres. The assessment was accompanied by IPC training and visual workplace reminders and done in pre- and post- phases to evaluate possible impact of these IPC activities.

The overall knowledge score in the Faranah Regional Hospital was 32.0 out of 44 at baseline, and did not change in the first, but increased significantly by 3.0 points in the second follow-up. The healthcare workers felt closer proximity to SARS-CoV-2 overtime in addition to higher stress levels in all study sites. There was significant improvement across the observed triaging practices. Hand hygiene compliance showed a significant increase across study sites leading to 80% in Faranah Regional Hospital and 63% in healthcare centers. The average consumption of ABHR per consultation was 3.29 mL with a peak in February 2020 of 23 mL.

Despite increased stress levels among HCWs, the ongoing IPC partnership well prepared the FRH in terms of triaging processes with a stronger impact on IPC practice than on theoretical knowledge. Throughout the pandemic, global shortages and surges in consumption did not affect the continuous ABHR provision of the FRH. This highlights local ABHR production as a key pandemic preparedness strategy.

Acute ischemic stroke (AIS) patients with active COVID-19 infection often have more severe symptoms and worse recovery. COVID-19 infection can cause gut microbiota dysbiosis, which is also a risk factor for poor outcomes in AIS patients. However, the association between gut microbiota and functional outcomes among AIS patients with COVID-19 infection has not been fully clarified yet. In this study, we performed 16S rRNA gene sequencing to characterize the gut microbial community among AIS patients with acute COVID-19 infection, AIS patients with post-acute COVID-19 infection, and AIS patients without COVID-19 infection. We found that AIS patients with acute COVID-19 experienced poorer recovery and significant gut dysbiosis, characterized by higher levels of Enterobacteriaceae and lower levels of Ruminococcaceae and Lachnospiraceae. Furthermore, a shorter time window (less than 28 days) between COVID-19 infection and stroke was identified as a risk factor for poor functional outcomes in AIS patients with COVID-19, and the enrichment of Enterobacteriaceae was indicated as a mediator in the relationship between infection time window and poor stroke outcomes. Our findings highlight the importance of early intervention after COVID-19 infection, especially by regulating the gut microbiota, which plays a role in the prognosis of AIS patients with COVID-19 infection.IMPORTANCEThe gut microbiota plays an important role in the association between respiratory system and cerebrovascular system through the gut-lung axis and gut-brain axis. However, the specific connection between gut bacteria and the functional outcomes of acute ischemic stroke (AIS) patients with COVID-19 is not fully understood yet. In our study, we observed a significant decrease in bacterial diversity and shifts in the abundance of key bacterial families in AIS patients with acute COVID-19 infection. Furthermore, we identified that the time window was a critical influence factor for stroke outcomes, and the enrichment of Enterobacteriaceae acted as a mediator in the relationship between the infection time window and poor stroke outcomes. Our research provides a new perspective on the complex interplay among AIS, COVID-19 infection, and gut microbiota dysbiosis. Moreover, recognizing Enterobacteriaceae as a potential mediator of poor stroke prognosis offers a novel avenue for future exploration and therapeutic interventions.

The co-occurrence of infectious diseases (ID) and non-communicable diseases (NCD) is widespread, presenting health service delivery challenges especially in low-and middle-income countries (LMICs). Integrated health care is a possible solution but may require a paradigm shift to be successfully implemented. This literature review identifies integrated care examples among selected ID and NCD dyads. We searched PubMed, PsycINFO, Cochrane Library, CINAHL, Web of Science, EMBASE, Global Health Database, and selected clinical trials registries. Eligible studies were published between 2010 and December 2022, available in English, and report health service delivery programs or policies for the selected disease dyads in LMICs. We identified 111 studies that met the inclusion criteria, including 56 on tuberculosis and diabetes integration, 46 on health system adaptations to treat COVID-19 and cardiometabolic diseases, and 9 on COVID-19, diabetes, and tuberculosis screening. Prior to the COVID-19 pandemic, most studies on diabetes-tuberculosis integration focused on clinical service delivery screening. By far the most reported health system outcomes across all studies related to health service delivery (n = 72), and 19 addressed health workforce. Outcomes related to health information systems (n = 5), leadership and governance (n = 3), health financing (n = 2), and essential medicines (n = 4)) were sparse. Telemedicine service delivery was the most common adaptation described in studies on COVID-19 and either cardiometabolic diseases or diabetes and tuberculosis. ID-NCD integration is being explored by health systems to deal with increasingly complex health needs, including comorbidities. High excess mortality from COVID-19 associated with NCD-related comorbidity prompted calls for more integrated ID-NCD surveillance and solutions. Evidence of clinical integration of health service delivery and workforce has grown-especially for HIV and NCDs-but other health system building blocks, particularly access to essential medicines, health financing, and leadership and governance, remain in disease silos.

There is a significant burden of stroke in Asia. Asia has the largest population in the world in 2023, estimated at 4.7 billion. Approximately 9.5-10.6 million strokes will be anticipated annually in the backdrop of a diverse group of well-developed and less developed countries with large disparities in stroke care resources. In addition, Asian countries are in varying phases of epidemiological transition.

In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia, which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy, and cerebral venous thrombosis.

The review of selected literature and recent updates calls for attention to the different requirements for resources within Asia and highlights the breadth of cerebrovascular diseases still requiring further research and more effective therapies.

Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.

In the COVID-19 epidemic more patients presented with persistent postural-perceptual dizziness (PPPD), but it has received little attention by the doctors in China and many patients reject psychological measurements or scales. Therefore, there is an urgent need for an objective method to diagnose and evaluate PPPD.

To investigate the effect of the COVID-19 epidemic on elderly PPPD patients and define the relationship between prefrontal alpha rhythm asymmetry (FAA) by Electroencephalography (EEG) and PPPD.

This case-control study was conducted to discuss the differences of elderly outpatients (>60 years) with PPPD during the peak period of COVID-19 in 2020 and the corresponding period in 2019, and collect the prefrontal FAA value in PPPD during COVID-19 outbreak, which were compared to its FAA in healthy control.

Compared with the same period in 2019, the number of elderly PPPD patients during the epidemic period in 2020 increased significantly (16.4%, p = 0.000, x2 =31.802) . The left alpha wave signal power (F3) was significantly higher than the right alpha wave signal power (F4) (Z= -3.073, p = 0.002). In PPPD patients FAA were significantly lower in patients compared to control group (Z = -11.535, p = 0.000). There was a negative correlation between FAA and HAMA scores (R2 =0.906, p < 0.05) and a negative correlation between FAA and HAMD scores (R2 =0.859, p < 0.05), too.

The increase in cases of elderly PPPD patients is most likely attributed to the mental health in older adults during the COVID-19 pandemic. Less left frontal brain activity in EEG may be related to elderly PPPD.

Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain.

A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization.

We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported.

Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.

Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed.

To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services.

We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary.

Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world.

Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.

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.

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.

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).

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.

This study aims to evaluate whether the first wave of the COVID-19 pandemic resulted in a deterioration in the quality of care for socially and/or clinically vulnerable stroke and ST-segment elevation myocardial infarction (STEMI) patients.

Two cohorts of STEMI and stroke patients in the Aquitaine neurocardiovascular registry.

Six emergency medical services, 30 emergency units, 14 hospitalisation units and 11 catheterisation laboratories in the Aquitaine region in France.

This study involved 9218 patients (6436 stroke and 2782 STEMI patients) in the neurocardiovascular registry from January 2019 to August 2020.

Care management times in both cohorts: first medical contact-to-procedure time for the STEMI cohort and emergency unit admission-to-imaging time for the stroke cohort. Associations between social (deprivation index) and clinical (age >65 years, neurocardiovascular history) vulnerabilities and care management times were analysed using multivariate linear mixed models, with an interaction on the time period (pre-wave, per-wave and post-first COVID-19 wave).

The first medical contact procedure time was longer for elderly (p<0.001) and 'very socially disadvantaged' (p=0.003) STEMI patients, with no interaction regarding the COVID-19 period (age, p=0.54; neurocardiovascular history, p=0.70; deprivation, p=0.64). We found no significant association between vulnerabilities and the admission imaging time for stroke patients, and no interaction with respect to the COVID-19 period (age, p=0.81; neurocardiovascular history, p=0.34; deprivation, p=0.95).

This study revealed pre-existing inequalities in care management times for vulnerable STEMI and stroke patients; however, these inequalities were neither accentuated nor reduced during the first COVID-19 wave. Measures implemented during the crisis did not alter the structured emergency pathway for these patients.

NCT04979208.

Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost-utility analysis of telestroke, using China as a case study.

We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost-utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results.

Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost-utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results.

Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China.

An international public health emergency has resulted from the emergence of the new coronavirus-2. Both direct and indirect influences have been felt on the treatment of acute stroke. However, no conclusive link between COVID-19 and the alleged decline in admissions for stroke-related reasons has been established, and the findings of recent studies are contentious. Most of those researches are not made use of authentic data. Therefore, the goal of this study is to examine how the COVID-19 pandemic has affected hospital admissions for stroke patients, to provide a basis for managing stroke patients in hospitals during COVID-19 pandemic.

This retrospective study took place at the People's Hospital of Peking University in Beijing, China. For each patient, interventions such as the application of tissue plasminogen activator (tPA) were examined. We recorded each patient's outcomes. The stroke patients' hospital admissions were compared to the average of the prior year. As the time span of interest, we selected the epidemic period (January 2020 to December 2020).

When compared to the previous year in the pre-COVID period, mean monthly stroke hospitalizations decreased during the pandemic by 54.42% (P<0.001); average lengths of stay (ALOS) increased; and non-emergency admissions decreased by 78.8% (P<0.001). The monthly volume of stroke patients exceeding the intravenous thrombolysis (IVT) window decreased by 25% and 59.73%, respectively (P <0.001). There was a 5.3% increase in the percentage of IVT or within IVT time window in male stroke patients (p=0.019; p=0.049). During COVID-19, the proportion of non-local patients among male stroke patients decreased by 10% compared with the previous year (p=0.006).

The COVID-19 epidemic has had a negative impact on stroke management in China, healthcare systems must work to assess and adapt to the new reality.

The COVID-19 pandemic resulted in suboptimal care for ischaemic stroke. Patients with diabetes mellitus (DM), a high-risk group for stroke, had compromised routine care during the pandemic, which increases the chance of stroke. We examined influence of the COVID-19 pandemic on the management of ischaemic stroke in patients with DM in South Korea.

Retrospective, nationwide, population-based cohort study.

Data from the National Emergency Department Information System.

We analysed 11 734 patients diagnosed with acute ischaemic stroke who underwent intravenous thrombolysis or endovascular thrombectomy between 2019 (the reference year) and 2020 (the pandemic year). Among them, 1014 subjects with DM were analysed separately.

The frequency of emergency department (ED) visits, time from symptom onset to ED, from ED visit to admission and in-hospital mortality were compared between two periods in the overall population and in patients with DM.

During the pandemic, the incidence of ischaemic stroke requiring urgent procedures increased by 7.57% in total and by 9.03% in patients with DM. Time delay from symptom onset to ED (reference vs pandemic, total: 1.50 vs 1.55 hours; p<0.01) and from ED visit to admission (total: 3.88 vs 3.92 hours; p=0.02) occurred during the pandemic in the overall population, but not significantly in patients with DM specifically. Older patients with DM showed higher chances of intensive care unit (ICU) admission during the pandemic: 53.5% vs 62.8% in age 70-79, 60.5% vs 71.9% in age 80-89 and 20.0% vs 70.8% in age ≥90 years (all p=0.01). There was no significant difference in in-hospital mortality between two periods (total: 8.2% vs 8.4%, p=0.65; DM: 8.1% vs 6.7%, p=0.25).

During the COVID-19 pandemic, the incidence of ischaemic stroke requiring urgent procedures increased, and older patients with DM showed a higher ICU admission rate. However, the pandemic was not associated with an increased in-hospital stroke mortality.

The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH).

This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH.

Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups.

From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality.

Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention.

Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817.

The COVID-19 pandemic produced unprecedented challenges to healthcare systems. These challenges were amplified in the setting of endovascular thrombectomy (EVT) for large vessel occlusion strokes given the time-sensitive nature of the procedure.

To assess the impact of the COVID-19 pandemic on service provision at the primary endovascular stroke centre in Ireland.

A retrospective review of the National Thrombectomy Service database was performed. All patients undergoing EVT from 1 January to 31 December inclusive of 2019 to 2021 were included. Patient demographics, functional outcomes and endovascular treatment time metrics were recorded.

Data from 2019, 2020 and 2021 were extracted. Three hundred seven thrombectomies were performed in 2019 and 2020; this number increased to 327 in 2021. Median time from arrival to groin puncture for thrombectomy was 64 min in 2019, increasing to 65 min in 2020. In 2021, this decreased to 52 min. Median time taken from groin puncture to first perfusion remained stable from 2019 to 2021 years at 20 min. Total duration of emergency thrombectomies reduced from 32 min in 2019 to 27 min in 2020. This increased to 29 min in 2021.

Despite the myriad of challenges presented by the pandemic, service provision at the primary Irish ESC, and the referring hospitals, has proven to be robust. Procedural time metrics were maintained whilst the expected reduction in number of EVTs performed did not materialise, there actually being a significant increase in number of EVTs performed in the pandemic's second year.

During the early phase of the COVID-19 pandemic, some infection control measures were implemented to keep people safe and control the spread of the virus. These measures however were observed to cause significant delay or interruption in the delivery and utilization of healthcare services. The purpose of this study was to determine the impact of the COVID-19 pandemic on the utilization and delivery of healthcare services by outpatients in Nigeria during the early phase of the pandemic. A retrospective cross-sectional study design was utilized. We sampled 373 outpatients who had received healthcare services before and during the pandemic in the University College Hospital, Ibadan using convenience sampling. Descriptive and inferential statistics (t-test) were carried out and the level of significance was set as P<0.05. Healthcare utilization was significantly impacted by the pandemic as there was a reduction in hospital visits by patients during the pandemic (P<0.0003). Restriction of movement and fear of contracting the virus was identified as reasons for the reduction in healthcare services utilization in about 59% of the participants. Patients rated the quality healthcare services delivered to them as 'average' during the pandemic as opposed to 'good' before the pandemic. The findings of this study showed that the COVID-19 pandemic had a significant impact on patients' utilization of healthcare services as well as the delivery of adequate healthcare services in the hospital during the early phases of the pandemic. Therefore, we recommend that efforts be made to improve hospitals and nationwide preparedness for future pandemics to prevent healthcare interference and delay.

Anterior shoulder instability causes functional changes that affect patients' quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability.

To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings.

A questionnaire was administered to both groups and a descriptive analysis of the results was performed.

51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%.

Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients' decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.

Aim of this study was to analyze long-term trends of hospitalizations, treatment regimen and in-hospital mortality of in-patients with acute mesenteric ischemia (AMI) over the past decade and effects of the SARS-CoV2-pandemic.

We analyzed fully anonymized data from the German Federal Statistical Office of patients with AMI between 2010 and 2020. Besides descriptive analyses of age, gender, in-hospital mortality, comorbidity burden and treatment regimen, multivariable logistic regression analyses were performed to identify independent variables associated with in-hospital mortality and different treatment.

A total of 278,121 hospitalizations (120,667 male [43.4%], mean age 72.1 years) with AMI were included in this study. The total number of hospitalizations increased from 2010 (n = 24,172) to 2019 (n = 26,684) (relative increase 10.4%). In-hospital mortality decreased over the past decade from 36.6% to 2010 to 31.1% in 2019 (rel. decrease 15.2%). Independent risk factors for in-hospital mortality were older age (OR = 1.03 per year), higher comorbidity burden (OR = 1.06 per point in van Walraven score [vWs]), male gender (OR = 1.07), AMI as a secondary diagnosis (OR = 1.44), and the need for surgical (visceral surgery: OR = 1.38, vascular surgery: OR = 3.33) and endovascular treatment (OR = 1.21). We report a decline in hospitalizations during the first wave of infection in spring 2020 (rel. decrease 9.7%).

In-hospital mortality rate has declined over the past decade, but remains high at above 30%. Older age, increased comorbidity and male gender are independent factors for in-hospital mortality. Hospitalizations requiring vascular surgery are associated with high in-hospital mortality, followed by visceral surgery and endovascular approaches. The first wave of the SARS-CoV2-pandemic in spring 2020 implied a decrease in hospital admissions.

Timely treatment of acute stroke depends on early identification and triage. Improved methods for recognition of stroke in the prehospital setting are needed. We aimed to assess whether use of the National Institutes of Health Stroke Scale (NIHSS) by paramedics in the ambulance could improve communication with the hospital, augment triage, and enhance diagnostic accuracy of acute stroke.

The Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) was a stepped-wedge, single-blind, cluster-randomised controlled trial. Patients with suspected acute stroke, who were evaluated by paramedics from five ambulance stations in Oslo, Norway, were eligible for inclusion. The five ambulance stations (defined as clusters) all initially managed patients according to a standard stroke protocol (control group), with randomised sequential crossover of each station to the intervention group. The intervention consisted of supervised training on NIHSS scoring, a mobile application to aid scoring, and standardised communication with stroke physicians. Random allocation was done via a simple lottery draw by administrators at Oslo University Hospital, who were independent of the research team. Allocation concealment was not possible due to the nature of the intervention. The primary outcome was the positive predictive value (PPV) for prehospital identification of patients with a final discharge diagnosis of acute stroke, analysed by intention to treat. Prespecified secondary safety outcomes were median prehospital on-scene time and median door-to-needle time. This trial is registered with ClinicalTrials.gov, NCT04137874, and is completed.

Between June 3, 2019, and July 1, 2021, 935 patients were evaluated by paramedics for suspected acute stroke. 134 patients met exclusion criteria or did not consent to participate. The primary analysis included 447 patients in the intervention group and 354 in the control group. There was no difference in PPV for prehospital identification of patients with a final discharge diagnosis of acute stroke between the intervention group (48·1%, 95% CI 43·4-52·8) and control group (45·8%, 40·5-51·1), with an estimated percentage points difference between groups of 2·3 (95% CI -4·6 to 9·3; p=0·51). Median prehospital on-scene time increased by 5 min in the intervention group (29 min [IQR 23-36] vs 24 min [19-31]; p<0·0001), whereas median door-to-needle time was similar between groups (26 min [21-36] vs 27 min [20-36]; p=0·90). No prehospital deaths were reported in either group.

The intervention did not improve diagnostic accuracy in patients with suspected stroke. A general increase in prehospital time during the pandemic and the identification of smaller strokes that require more deliberation are possible explanations for the increased on-scene time. The ParaNASPP model is to be implemented in Norway from 2023, and will provide real-life data for further research.

Norwegian Air Ambulance Foundation and Oslo University Hospital.

Low-to-moderate dose statins (LMDSs) are more commonly used among Asian acute ischemic stroke (AIS) patients in clinical practice. However, the correlation between the LMDS use and prognosis has not been evaluated in AIS patients with conventional medication treatment alone. This study aimed to investigate the influence of LMDS on the prognosis of AIS patients and how prognosis and potential prognostic factors interact with different statin doses.

This retrospective cohort study included AIS patients who were admitted within 7 days after symptom onset and received conventional medication treatment alone from November 2019 to November 2020 in the Neurology, Department of West China Hospital, Sichuan University. From a total of 782 initial patients, a final cohort of 327 patients was included in the study. These patients were divided into three groups based on statin doses: non-statin (48 patients), LMDS (152 patients), and high-dose statin (HDS) (127 patients). The follow-up period was 3 months after the onset of stroke and the primary outcome was defined as a modified Rankin scale (mRS) score of 0 to 2 at 3 months, secondary outcomes were hemorrhagic transformation (HT) and death within 3 months. Stratified analysis was also conducted to test the robustness of the relationship between the use of different statin doses and functional outcomes in various subgroups.

Compared with non-statin therapy, both LMDS therapy and HDS therapy were associated with good functional outcomes [odds ratio (OR) =3.68, 95% confidence interval (CI): 1.13-12.01, P=0.0309; OR =3.45, 95% CI: 1.06-11.26, P=0.0402, respectively] and a lower risk of HT (OR =0.30, 95% CI: 0.11-0.86, P=0.0253; OR =0.36, 95% CI: 0.13-0.99, P=0.0488, respectively). However, there was no significant difference in all-cause death within 3 months among the three groups (OR =0.84, 95% CI: 0.29-2.46, P=0.7468; OR =0.76, 95% CI: 0.26-2.22, P=0.6104). Additionally, no significant differences were observed between LMDS therapy and HDS therapy regarding good functional outcomes at 3 months (OR =0.94, 95% CI: 0.50-1.77, P=0.8411) and the occurrence of HT (OR =1.19, 95% CI: 0.47-3.02, P=0.7093). The results of the relationship between different statin doses and 3-month good functional outcome were consistent after interaction tests.

Our findings provide evidence for the benefit and safety of LMDS therapy in AIS patients with medication treatment alone. LMDS therapy is associated with favorable impacts on 3-month functional outcomes and a reduced risk of HT compared to non-statin therapy. There were no significant differences in achieving 3-month good functional outcome, the risk of HT or death within 3 months were observed between LMDS and HDS therapy in our study. Further studies with prospective design and larger sample sizes are necessary to validate our results.

Not in the history of transmissible illnesses has there been an infection as strongly associated with acute cerebrovascular disease as the novel human coronavirus SARS-CoV-2. While the risk of stroke has known associations with other viral infections, such as influenza and human immunodeficiency virus, the risk of ischemic and hemorrhagic stroke related to SARS-CoV-2 is unprecedented. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has so profoundly impacted psychosocial behaviors and modern medical care that we have witnessed shifts in epidemiology and have adapted our treatment practices to reduce transmission, address delayed diagnoses, and mitigate gaps in healthcare. In this narrative review, we summarize the history and impact of the COVID-19 pandemic on cerebrovascular disease, and lessons learned regarding the management of patients as we endure this period of human history.

The global COVID-19 pandemic has had a devastating effect on global health, resulting in a strain on healthcare services worldwide. The faster a patient with acute ischemic stroke (AIS) receives reperfusion treatment, the greater the odds of a good functional outcome. To maintain the time-dependent processes in acute stroke care, strategies to reorganize infrastructure and optimize human and medical resources were needed.

Data from AIS patients who received thrombolytic therapy were prospectively assessed in the emergency department (ED) of Hospital de Clínicas de Porto Alegre from 2019 to 2021. Treatment times for each stage were measured, and the reasons for a delay in receiving thrombolytic therapy were evaluated.

A total of 256 patients received thrombolytic therapy during this period. Patients who arrived by the emergency medical service (EMS) had a lower median door-to-needle time (DNT). In the multivariable analysis, the independent predictors of DNT >60 min were previous atrial fibrillation (OR 7) and receiving thrombolysis in the ED (OR 9). The majority of patients had more than one reason for treatment delay. The main reasons were as follows: delay in starting the CT scan, delay in the decision-making process after the CT scan, and delay in reducing blood pressure. Several actions were implemented during the study period. The most important factor that contributed to a decrease in DNT was starting the bolus and continuous infusion of tPA on the CT scan table (decreased the median DNT from 74 to 52, DNT ≤ 60 min in 67% of patients treated at radiology service vs. 24% of patients treated in the ED). The DNT decreased from 78 min to 66 min in 2020 and 57 min in 2021 (p = 0.01).

Acute stroke care continued to be a priority despite the COVID-19 pandemic. The implementation of a thrombolytic bolus and the start of continuous infusion on the CT scan table was the main factor that contributed to the reduction of DNT. Continuous monitoring of service times is essential for improving the quality of the stroke center and achieving better functional outcomes for patients.

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.

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.

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.

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.

Tenecteplase (TNK) is a fibrinolytic drug that is administrated in a single bolus, recommended in eligible patients with acute ischemic stroke prior to mechanical thrombectomy. This study explores its usefulness in adverse situations, such as the SARS-CoV-2 pandemic. We conducted a retrospective study involving consecutive patients with suspected acute ischemic stroke treated either with intravenous fibrinolysis with alteplase during 2019 or with TNK (.25 mg/kg) between March 2020 and February 2021. A comparative analysis was made to compare patient treatment times and prognosis. A total of 117 patients treated with alteplase and 92 with TNK were included. No significant differences were observed in age, main vascular risk factors or previous treatments. The median National Institutes of Health Stroke Scale was 8 in the alteplase group and 10 in those treated with TNK (P = .13). Combined treatment with mechanical thrombectomy was performed in 47% in the alteplase group and 46.7% in the TNK group; Thrombolysis In Cerebral Infarction scale 2b-3 recanalization was achieved in 83% and 90.7%, respectively (P = .30). There was a decrease in onset-to-needle median time (165 min vs 140 min, P < .01) and no significant variations in door-needle median time. There was no significant difference in the incidence of symptomatic hemorrhagic transformation in mortality or functional independence at 3 months. The easier administration of TNK has improved the accessibility of fibrinolytic therapy, even in adverse circumstances, such as the COVID-19 pandemic. Its use appears to be safe and effective, even in patients who are not candidates for mechanical thrombectomy.

The cost-effectiveness of Cerebrolysin as an add-on therapy for moderate-severe acute ischemic stroke is a topic that remains understudied. This study aims to address this gap by performing a comprehensive cost-utility analysis using both deterministic and probabilistic methods from a payer perspective and within the Romanian inpatient care setting. Quality-adjusted life years (QALYs) were calculated using partial individual patient data from the 2016 Cerebrolysin and Recovery After Stroke (CARS) trial, utilizing three different health state valuation models. Cost data was extracted from actual acute care costs reported by Romanian public hospitals for reimbursement purposes for patients included in the CARS study. Incremental cost-effectiveness ratios were calculated for each treatment arm for the duration of the clinical trial. Deterministic analysis based on sample mean values indicates Cerebrolysin would be cost-effective at a threshold between roughly 18.8 and 29.9 thousand EUR, depending on valuation techniques. Probabilistic sensitivity analysis results indicate an 80% chance probability of cost-effectiveness of Cerebrolysin as an add-on therapy for acute ischemic stroke, considering a willingness-to-pay threshold of 50,000 EUR in a 90-day timeframe after stroke. Further economic evaluations of Cerebrolysin are needed to strengthen these findings, covering a timeframe of at least 12 months after the acute incident, which would account for treatment effects spanning beyond the first 90 days after ischemic stroke. These should be conducted to determine its cost-effectiveness under various care settings and patient pathways. Most importantly, modelling techniques are needed to answer important questions such as the estimates of population gain in QALYs after acute administration of Cerebrolysin and the potential offsetting of direct medical costs as a result of administering the intervention.