PRS28 A Scoping Review of Consequences of Untreated Stroke: Economic Burden Due to COVID-19?

Stroke is associated with high costs for society and healthcare systems. Specialists agree on the importance of early treatment to improve the prognosis of patients. We identified the international literature regarding untreated stroke’s main consequences in the context of the decrease in emergency care for ischemic stroke during the covid-19 outbreak. A Scoping Review was conducted following the PCC strategy (population, context, and concept) to identify the international literature regarding the decrease in stroke-emergency care and the main consequences of untreated stroke. The search was carried out in PubMed, Cochrane, ScienceDirect, Google, and Google Scholar, combining Mesh terms and Boolean terms. N=1748 articles were retrieved, and n=53 were included for analysis. International data shows a decrease in emergency care (20% less), endovascular procedures (up to 32% less), and indications for thrombolysis (5.5% less). Fewer admissions for stroke (46% less) are temporally related to the pandemic’s onset and quarantines. Untreated stroke patients are more likely to present severe stroke, 13% more severe disability, 12% more functional dependence at 6-12 months (p<0.001), higher rehabilitation costs and hospital length-of-stay (>15% more), more cognitive disability (16.6% more likely for stroke recurrence (p=0,006)) and 4-6% more likely to die, compared to patients treated with thrombolysis (r-tPA). The increase in patients with unfavorable outcomes due to untreated stroke, including increased disability and death, will put an added economic burden on healthcare systems and society, already greatly affected by the coronavirus pandemic. This information justifies carrying-out future studies of costs borne by families.