Characteristics and outcomes among US patients hospitalized for ischemic stroke before vs during the COVID-19 pandemic

Abstract

IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis andwere not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7%male; 63.4%White; 26.3% aged-80 years)were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9%male; 62.8%White; 24.6%aged-80 years) were allocated to the non COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5%White; 21.3%aged-80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4%and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5%and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2%vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2%vs 63.2%vs 56.6%) but were more likely to have diabetes (39.8%vs 40.5%vs 53.0%), obesity (16.2%vs 18.4%vs 24.5%), acute coronary syndrome (8.0% vs 9.2%vs 15.8%), or pulmonary embolus (1.9% vs 2.4%vs 6.8%) and to require intubation (11.3%vs 12.3%vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95%CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95%CI, 3.15-4.05). CONCLUSIONS AND RELEVANCE In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high.