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HK stroke patients presenting to hospitals 1 hour later during COVID-19

Natalia Reoutova
27 Apr 2020
From left: Dr William Leung, Dr Gary Lau, Dr Anderson Tsang, and Dr Kay-Cheong Teo

Data from the Stroke Research and Prevention Group at the University of Hong Kong (HKU Stroke) indicate that stroke patients sought medical attention at the Accident and Emergency (A&E) Department of Queen Mary Hospital (QMH) 1 hour later, on average, between 23 January and 24 March 2020 compared with the same period in 2019.

Stroke is the second leading cause of death and a major cause of disability worldwide. [Semin Neurol 2018;38:208-211] “Delays in seeking care in stroke patients could be detrimental to stroke outcomes. It is estimated that every minute that stroke is left untreated, 1.9 million brain neurons are lost,” said Dr Gary Lau, Director of HKU Stroke in a press release. [Stroke 2006;37:263-266]

Among the 73 patients diagnosed with stroke at QMH in the first 2 months following the first local case of coronavirus disease 2019 (COVID-19) (23 January 2020), the average time to presentation with stroke symptoms to the A&E department was 154 minutes, as compared with 95 minutes among the 89 patients admitted for stroke at the same hospital during the same period last year.  

Importantly, between 23 January and 24 March 2020, only 55 percent of the stroke patients presented to hospitals within the therapeutic time window for thrombolysis treatment, which lasts 4.5 hours from symptom onset. [N Engl J Med 2008; 359:1317-1329] In contrast, 72 percent of patients reached a hospital within the therapeutic time frame during the same period last year.

“Earlier treatment is associated with better stroke outcomes and any delays in seeking care would seriously jeopardize the patient’s eligibility for treatment. Our results unfortunately show that as patients with stroke are presenting to hospital later during the COVID-19 pandemic, far fewer are eligible for thrombolysis,” commented Lau.

In addition to stroke patients presenting later to hospitals during the COVID-19 pandemic, the researchers also found that fewer patients are seeking medical attention for transient ischaemic attacks (TIAs), also known as mini-strokes. Of all patients who presented with stroke-like symptoms between 23 January and 24 March 2020, only 4 percent were diagnosed with a TIA, as compared with 16 percent of all suspected stroke admissions during the same period last year.

“Our results are worrying as they highlight the reluctance of stroke patients to seek timely hospital treatment during the current COVID-19 pandemic. Up to 20 percent of TIA patients may develop a disabling stroke within the following 3 months, while early treatment of TIA could reduce their risk of having a stroke by up to 80 percent,” said Dr Kay-Cheong Teo of the Division of Neurology, HKU. [Lancet 2007;370:1398-1400]

Reassuringly, during the COVID-19 pandemic, in-hospital stroke services at QMH appear not to have been affected, as the average time from hospital admission to delivery of treatment remained similar to the time before COVID-19.

“We are committed to providing the best acute stroke treatment, including thrombolysis and endovascular thrombectomy, to our patients despite the pandemic. We should make every effort to ensure that acute stroke care is not compromised, and continue to provide potentially treatable stroke patients with appropriate treatment,” said Dr Anderson Tsang, Co-Director of HKU Stroke.

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