BMJ Open (Jan 2024)

Social and clinical vulnerability in stroke and STEMI management during the COVID-19 pandemic: a registry-based study

  • Jérome Berge,
  • Gaultier Marnat,
  • Emmanuel Ellie,
  • Igor Sibon,
  • Basile Ondze,
  • Ludovic Lucas,
  • Xavier Combes,
  • Catherine Pradeau,
  • Pierre Coste,
  • Jean-Luc Banos,
  • Nicolas Delarche,
  • François Rouanet,
  • Pierre Fournier,
  • Patricia Bernady,
  • David Higue,
  • Julie Péron,
  • Stephanie Bannier,
  • Virginie Heydel,
  • Nathalie Goulois,
  • Francois Orcival,
  • Stephanie Vandentorren,
  • Jean-Louis Leymarie,
  • Bernard Karsenty,
  • Emilie Lesaine,
  • Sandrine Domecq,
  • Laura Cetran,
  • Sahal Miganeh-Hadi,
  • Floriane Sevin,
  • Stéphanie Demasles,
  • Régis Hubrecht,
  • Florence Francis,
  • Florence Saillour,
  • Jean Faucheux,
  • Elena Leca Radu,
  • Gaëlle Seignolles,
  • Cécile Chazalon,
  • Maria Dan,
  • Laurent Wong-So,
  • Miquel Martinez,
  • Claire Nocon,
  • Véronique Hostyn,
  • Jérémy Papin,
  • Philippe Bordier,
  • Philippe Casenave,
  • Laurent Maillard,
  • Isabelle Argacha,
  • Eliane Tidahy,
  • Lucie Ferraton,
  • Yousra Mostefai,
  • Djoumana Bakpa,
  • Christine Bartou,
  • Catherine Goze-Dupuy,
  • Hélène Lavocat,
  • Frédéric Senis,
  • Virginie Delonglee,
  • Didier Darraillans,
  • Tarak Mokni,
  • Bertrand Bataille,
  • Jean Lorendeau,
  • Anncy Eclancher,
  • Bruno Trogoff,
  • Véronique Chartroule,
  • Philippe Touchard,
  • Hervé Leyral,
  • Fogue Ngounou,
  • Catherine Scouarnec,
  • Bertrand Tahon,
  • Emmanuel Py,
  • Sorina Bidian,
  • Jean Fabre,
  • Nidhal Cherhabil,
  • Leila Baha,
  • Pierre-Arnaud Fort,
  • Vincent Maisonnave,
  • Luc Verhoeven,
  • Paul Claveries,
  • Emma Ansart,
  • Brice Lefevre,
  • Marie-Pierre Liepa,
  • Marc Lacrouts,
  • Jean-Baptiste Coustere,
  • Philippe Jarnier,
  • Nicolas Marque,
  • Jean-Marie Perron,
  • Akil Hassan,
  • Francois Casteigt,
  • Bernard Larnaudie,
  • Guillaume Laplace

DOI
https://doi.org/10.1136/bmjopen-2023-073933
Journal volume & issue
Vol. 14, no. 1

Abstract

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Objective This study aims to evaluate whether the first wave of the COVID-19 pandemic resulted in a deterioration in the quality of care for socially and/or clinically vulnerable stroke and ST-segment elevation myocardial infarction (STEMI) patients.Design Two cohorts of STEMI and stroke patients in the Aquitaine neurocardiovascular registry.Setting Six emergency medical services, 30 emergency units, 14 hospitalisation units and 11 catheterisation laboratories in the Aquitaine region in France.Participants This study involved 9218 patients (6436 stroke and 2782 STEMI patients) in the neurocardiovascular registry from January 2019 to August 2020.Primary outcome measures Care management times in both cohorts: first medical contact-to-procedure time for the STEMI cohort and emergency unit admission-to-imaging time for the stroke cohort. Associations between social (deprivation index) and clinical (age >65 years, neurocardiovascular history) vulnerabilities and care management times were analysed using multivariate linear mixed models, with an interaction on the time period (pre-wave, per-wave and post-first COVID-19 wave).Results The first medical contact procedure time was longer for elderly (p<0.001) and ‘very socially disadvantaged’ (p=0.003) STEMI patients, with no interaction regarding the COVID-19 period (age, p=0.54; neurocardiovascular history, p=0.70; deprivation, p=0.64). We found no significant association between vulnerabilities and the admission imaging time for stroke patients, and no interaction with respect to the COVID-19 period (age, p=0.81; neurocardiovascular history, p=0.34; deprivation, p=0.95).Conclusions This study revealed pre-existing inequalities in care management times for vulnerable STEMI and stroke patients; however, these inequalities were neither accentuated nor reduced during the first COVID-19 wave. Measures implemented during the crisis did not alter the structured emergency pathway for these patients.Trial registration number NCT04979208