Abstract / Summary
Abstract Introduction The COVID-19 pandemic necessitated lockdowns, potentially affecting stroke care. We evaluated changes in acute stroke treatment, diagnostic work-up, and secondary prevention during the first Swiss COVID-19 lockdown primarily by comparing the lockdown and post-lockdown periods; the 2015 cohort was used as historical context for secular changes. Methods We retrospectively analysed prospectively collected data from the Bernese Stroke Registry, including consecutive patients with acute ischaemic stroke receiving reperfusion therapy in 2015 ( n = 319), during lockdown (March 16-April 26/2020; n = 66), and post-lockdown 2020 ( n = 236). Baseline characteristics, treatment metrics, diagnostic work-up, secondary prevention and 3-month outcomes were compared. Analyses were unadjusted and exploratory, and no correction for multiple comparisons was applied. Results The centre treated 11.0 patients/week during lockdown and 25.4 patients/week post-lockdown (rate ratio 0.43, 95%CI 0.33–0.57, p < 0.001). Baseline characteristics, treatment metrics and functional outcome were similar between lockdown and post-lockdown patients. During lockdown, TEE was performed less frequently (20.0% vs. 39.1%, p = 0.004; risk ratio 0.51, 95%CI 0.31–0.85), telephone-follow-up was more common (40.9% vs. 26.7%, p = 0.016; risk ratio 1.53, 95%CI 1.07–2.19), as was antihypertensive prescription at 3 months (69.7% vs. 59.7%, p = 0.012). Compared with 2015, patients in 2020 were older (median 76.4 vs. 74.1 years, p = 0.024), had lower admission NIHSS scores (median 10 vs. 12, p = 0.002), and mRS (65.5% vs. 31.3% at mRS 0, p < 0.001). Reperfusion success improved (mTICI 3: 77.3% vs. 42.0%, p < 0.001). Long-term ECG monitoring, TTE and statin use increased (first ECG: 58.4% vs. 42.7%, p = 0.002; second: 35.0% vs. 22.3%, p = 0.007; third: 24.8% vs. 10.4%, p < 0.001/TTE: 55.4% vs. 39.3%, p < 0.001/statins: 69.0% vs. 58.2%, p = 0.015). Hospital stay was shorter (median 3.03 vs. 3.93 days, p = 0.004) and inpatient rehabilitation less frequent (56.8% vs. 69.2%, p = 0.002), while 3-month functional outcome was similar. Conclusion Among patients who reached this single centre and received reperfusion therapy, the lockdown period coincided with a lower centre-based treatment rate, reduced TEE use, and increased telephone-based follow-up. The lower TEE rate was likely multifactorial and cannot be attributed solely to lockdown restrictions. Because untreated and non-presenting patients were not captured, the findings cannot be generalized to the overall stroke population. Differences between 2015 and 2020 should be interpreted as secular changes in stroke care rather than pandemic-related effects. Clinical trial number Not applicable.