Qualityofacute stroke care provided outside of stroke units declined during the COVID-19 pandemic in australia

Background and Aims: Globally, there were concerns about the quality of acute stroke care due to the COVID-19 pandemic. In this study, we compared the quality of acute stroke care provided in stroke units with alternate ward settings before and during the pandemic. Methods: Patients admitted with stroke or transient ischaemic attack from 61 hospitals contributing data to the Australian Stroke Clinical Registry in 2019 and 2020 were included. Interrupted time series analysis was conducted to assess trends in the provision of acute stroke care before and after the first wave (starting 1/3/2020) and second wave (between 9/7/2020-20/10/2020) of COVID-19 cases in Australia. Results: Overall, 38, 295 patients were available for analysis (n=19, 164 in 2019, n=19, 131 in 2020 [provisional sample]). There were no differences in age and sex between years (mean age 73 years, 56% male). Fewer patients were provided treatment in a stroke unit in 2020 compared to 2019 (72% vs 77%, p<0.001). There were greater declines in the provision of hyperacute aspirin and secondary prevention at discharge in alternate wards than stroke units during the second wave (between 0.41% and 1.31% per week). Provision of mobilisation and swallow screening/assessment declined in alternate wards only. Provision of care planning at discharge improved in alternate wards relative to stroke units by 0.49% per week during the first wave and 1.14% per week during the second wave. Conclusions: The COVID-19 pandemic has affected the quality of acute stroke care. It is essential that patients continue to be treated in stroke units.