Compromised evidence-based acute stroke care during the secondwave of the COVID-19 pandemic

Background and Aims: Following the first wave of the COVID-19 pandemic, infection control measures in health-care facilities have been intensified globally. We aimed to evaluate evidence-based processes of acute stroke care during the two waves of the pandemic. Methods: We abstracted data from patients with acute stroke who presented to the emergency department of a tertiary care hospital in Saxony, Germany during the first (03-06/2020, 100 days) and second (09-12/2020, 100 days) wave peaks of the pandemic. Evidence-based performance indicators including reperfusion therapies and acute stroke unit care and appropriate secondary prevention medication were compared between the two waves. Results: Of 579 stroke patients (ages 73.5±14.1 years, 44.9% females), 330 (57%) were admitted during the first and 249 [43%] during the second wave (p=.64). Patients were more frequently tested positive for SARS-CoV-2 during the second than the first wave (11 [4.4%] vs. 0;p<.001). There were no differences in the overall delivery of reperfusion therapies (36.4% vs. 37%;p=.89), door-to-groin time (1.3±1.1 vs. 1.4 ±0.8 hours;p=.5) and door-to-needle time (0.7±0.4 vs. 0.9±0.6 hours;p=.17). However, patients in the second wave were more frequently deprived of immediate acute stroke unit care (5 [1.5%] vs. 17 [6.8%];p=.001) due to infection control strategies and had longer hospitalization (9.5±8.2 vs.12.5±11.2 days;p<.0001). Clinical severity, stroke etiology, appropriate secondary prevention medication and discharge disposition were comparable between both waves (p=n.s.). Conclusions: Cohorting and isolation strategies for suspected and confirmed COVID-19 patients may adversely affect evidence-based processes of care in acute stroke.