The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: Retrospective sequential comparison

Background and Aims: To evaluate the impact of the first wave of the UK COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. Methods: This retrospective study included adults with acute stroke admitted to the University College London Hospital Hyperacute Stroke Unit who were included in the Stroke Investigation Group in North and central London registry. We included two separate cohorts of consecutively enrolled patients at two-time points: 16th March -16th May 2018 and 16th March -16th May 2020. Patients in both cohorts completed the Patient-Reported Outcomes Measurement Information System-29 version 2.0 measure 30 days after stroke. Results:We included 205 patients who were alive at 30 days (106 before and 99 during the COVID-19 pandemic), of whom 98% provided outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with: increased anxiety (β=-28.0 95% Cl [-31.0, -25.0] p<0.001), fatigue (β=-9.3 95% Cl [-11.8, -6.9] p<0.001), sleep disturbance (β=-2.3 95% Cl [-4.2, -0.4] p=0.018), pain interference (β=-10.8 95% Cl [-13.3, -8.2] p<0.001);reduced physical function (β=5.2 95% Cl [2.6, 7.7] p<0.001) and participation in social roles and activities (b=6.9 95% Cl [4.9, 8.8] p<0.001). Conclusions: Compared with the pre-pandemic cohort, patients admitted during the first wave of the COVID-19 pandemic reported poorer health outcomes in all domains and independent of confounding factors. Stroke service planning for any future pandemic should include measures to mitigate the major adverse impact on health outcomes.