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Abstract
Originally Published 30 January 2025
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Abstract WMP76: Trends in ischemic stroke hospitalization and outcomes in the United States pre- and peri- COVID-19 pandemic: A National Inpatient Sample study

Abstract

Importance: The COVID-19 pandemic significantly disrupted healthcare systems worldwide, impacting the management of acute ischemic stroke (AIS). Understanding changes in AIS admissions, treatment patterns&outcomes during the pandemic is essential for optimizing stroke care in future public health crises.
Objective: To evaluate the impact of the COVID-19 pandemic on AIS admissions, treatment utilization, complications&outcomes in the U.S. from 2016 to 2021, focusing on the pre-pandemic (2016-2019)&peri-pandemic (2020-2021) periods.
Methods: A retrospective observational cohort study utilizing the National Inpatient Sample (NIS) nationwide database, analyzing weighted hospital discharge records over 6 years, encompassing urban, rural, teaching &non-teaching hospitals.
Participants were AIS patients aged 18 years&older (n=3,154,154), identified using ICD-10 codes. Sociodemographic characteristics such as age, sex, race&comorbidities were evaluated. The mean patient age was 70.0 ± 0.03 years, with an average length of stay of 5.1 ± 0.01 days&an adjusted mean cost of $16,765 ± 71. Men accounted for 50.5% of the cohort. AIS hospitalizations from 2016 to 2021 were collected, comparing pre-&peri-pandemic periods. Primary outcomes included AIS admission trends, while secondary outcomes included reperfusion therapy utilization, intubation&ventilation rates, discharge disposition&complications.
Results: AIS admissions increased from 507,920 in 2016 to 535,694 in 2021. A demographic shift was observed, with the proportion of male patients rising from 49.8% to 51.4%&the mean age decreasing from 70.3 to 69.7 years (p < 0.0001). Most patients were White (69.5% in 2016), but their proportion decreased over time, while Black, Hispanic&Asian/Pacific Islander cases increased (p 0.5734). Reperfusion therapy usage increased, with mechanical thrombectomy (MT) rising from 2.2% to 5.6% in 6 years. Intubation/ventilation rates grew from 4.8% pre-COVID to 5.5% peri-COVID (p < 0.0001). Subarachnoid&intracerebral hemorrhage rates had increased throughout the 6 years in the group with MT-only intervention (p .011&.002, respectively).
Conclusions: The COVID-19 pandemic led to significant shifts in AIS hospitalization patterns, including changes in age distribution, increased reperfusion therapy use&rising complications. These findings highlight the need for adaptive public health strategies&resource allocation to maintain stroke care during future crises.

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Published online: 30 January 2025
Published in print: February 2025

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Keywords

  1. Interventional neurovascular
  2. Ischemic stroke
  3. Outcomes
  4. Neuroendovascular (for stroke)

Authors

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Alibay Jafarli, MD
University of Texas San Antonio, San Antonio, Texas, United States
Rachel Kasper, BS, MPH
University of New Mexico, Albuquerque, New Mexico, United States
Jeffrey Saver, BA, MD
GEFFEN SCHOOL OF MEDICINE AT UCLA, Los Angeles, California, United States
Louise McCullough, MD, PhD
McGovern Medical School at UTHealth, Houston, Texas, United States
Vasileios Lioutas, MD
BETH ISRAEL DEACONESS MEDICAL, Boston, Massachusetts, United States
Setareh Salehi Omran, MD
University of Colorado Denver, Aurora, Colorado, United States
Mario Di Napoli, MD
dell’Annunziata Hospital, L'Aquila, Sulmona, Italy
Behnam Mansouri, MD
Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
Lee Birnbaum, MD, MS
UTHSCSA, San Antonio, Texas, United States
Mohammed Ismail, MD
University of New Mexico, Albuquerque, New Mexico, United States
Atilla Ozcan Ozdemir, MD
Eskisehir Osmangazi University, Eskisehir, Turkey
Afshin Divani, PhD
University of New Mexico, Albuquerque, New Mexico, United States

Notes

For author disclosure information, please visit the AHA International Stroke Conference website.

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Abstract WMP76: Trends in ischemic stroke hospitalization and outcomes in the United States pre- and peri- COVID-19 pandemic: A National Inpatient Sample study
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