Continuous impact of the COVID-19 pandemic on the volumes and outcomes of acute ischemic stroke and myocardial infarction across its different “waves”

Background and Aims: The COVID-19 pandemic has wreaked havoc on the presentation, care and outcomes of patients with acute cerebrovascular and cardiovascular conditions. We sought to measure the national impact of the pandemic on the amount of care provided for acute ischemic stroke (AIS) and acute myocardial infarction (AMI) as measured by the hospitalization volumes and utilization of reperfusion therapy (intravenous thrombolysis [IVT] and/or mechanical thrombectomy [MT]) for AIS and percutaneous coronary interventions (PCI) for AMI over each pandemic “wave” compared to similar periods the prior year. In addition, we examined the changes in in-hospital mortality and hospital length of stay (LOS) across the respective periods. Methods: In this retrospective, observational study, we used the Premier Healthcare Nation-Wide US Database to measure the quantity of care for AIS and AMI. We analyzed the percentage change in the number of AIS/AMI admissions, IVT/MT for AIS and PCI for AMI across the different US “pandemic waves” (#1:March-May/2020;#2: June-August/2020;#3:September-December/2020) and the corresponding pre-pandemic periods. Generalized estimating equation models adjusted for study covariates were used to compared in-hospital mortality and LOS across the corresponding periods. Results: The amount of AIS and AMI care provided dropped significantly in relation to each of the COVID-19 waves. In addition, there was a general increase in terms of in-hospital mortality and a general decreased in LOS. Conclusions: Our findings shed light on the persistent health outcomes impact the COVID-19 pandemic has had on acute stroke and cardiac emergency care. The general public should be educated on the consequences of untreated acute conditions.