Frontiers in Neurology (Feb 2024)

Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis

  • Andy Lim,
  • Peter M. Rothwell,
  • Linxin Li,
  • Shelagh B. Coutts,
  • Michael D. Hill,
  • Maria Guarino,
  • Valentina Barone,
  • Francesca Rondelli,
  • Timothy Kleinig,
  • Reid Cornell-Farrow,
  • Martin Krause,
  • Miriam Wronski,
  • Shaloo Singhal,
  • Shaloo Singhal,
  • Henry Ma,
  • Henry Ma,
  • Thanh G. Phan,
  • Thanh G. Phan

DOI
https://doi.org/10.3389/fneur.2024.1351769
Journal volume & issue
Vol. 15

Abstract

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Background and aimRapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics.MethodsRelevant services were identified by literature search and contacted. Three years of monthly data were requested – a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model.ResultsSix centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI –1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI –7.8 to 1.9, p = 0.25), IVT (−14.3, 95% CI −36.7, 6.1, p < 0.01), and EVT (0, 95% CI –16.9 to 16.9, p = 0.98) counts. Proportion of ischemic strokes requiring IVT decreased from 13.2 to 11.4% (p < 0.05), but those requiring EVT did not change (16.0 to 16.7%, p = 0.33).ConclusionThis suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic – delays in seeking treatment in this group could be the target for public health intervention.

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