Acute Stroke Care in a New York City Comprehensive Stroke Center during the COVID-19 Pandemic

Agarwal, Shashank; Scher, Erica; Rossan-Raghunath, Nirmala; Marolia, Dilshad; Butnar, Mariya; Torres, Jose; Zhang, Cen; Kim, Sun; Sanger, Matthew; Humbert, Kelley; Tanweer, Omar; Shapiro, Maksim; Raz, Eytan; Nossek, Erez; Nelson, Peter K.; Riina, Howard A.; de Havenon, Adam; Wachs, Michael; Farkas, Jeffrey; Tiwari, Ambooj; Arcot, Karthikeyan; Parella, David Turkel; Liff, Jeremy; Wu, Tina; Wittman, Ian; Caldwell, Reed; Frontera, Jennifer; Lord, Aaron; Ishida, Koto; Yaghi, Shadi

BACKGROUND AND PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). METHODS: We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). RESULTS: A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p=0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 minutes, p=0.06), the time to alteplase administration (36 vs 35 minutes; p=0.83), door to reperfusion times (103 vs 97 minutes, p=0.18) and defect-free care (95.2% vs 94.7%; p=0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p=0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 – 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.