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Title: Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic.
Austin Authors: Myers, Laura J;Perkins, Anthony J;Kilkenny, Monique F;Bravata, Dawn M
Affiliation: Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), United States..
Department of Biostatistics, Indiana University School of Medicine, IUPUI, Indianapolis, IN, United States..
Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia..
Regenstrief Institute, Indianapolis, IN, United States..
VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H 1481 West 10th Street, Indianapolis, IN 46202, United States..
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States..
The Florey Institute of Neuroscience and Mental Health
Department of Emergency Medicine, Indiana University School of Medicine; Indianapolis, IN, United States..
Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States..
Issue Date: 5-Apr-2022
Date: 2022
Publication information: Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association 2022; 31(6): 106455
Abstract: Hospitalizations for acute ischemic stroke (AIS) and transient ischemic attack (TIA) decreased during the COVID-19 pandemic. We compared the quality of care and outcomes for patients with AIS/TIA before vs. during the COVID-19 pandemic across the United States Department of Veterans Affairs healthcare system. This retrospective cohort study compared AIS/TIA care quality before (March-September 2019) vs. during (March-September 2020) the pandemic. Electronic health record data were used to identify patient characteristics, quality of care and outcomes. The without-fail rate was a composite measure summarizing whether an individual patient received all of the seven processes for which they were eligible. Mixed effects logistic regression modeling was used to assess differences between the two periods. A decrease in presentations occurred during the pandemic (N = 4360 vs. N = 5636 patients; p = 0.003) and was greater for patients with TIA (-30.4%) than for AIS (-18.7%). The without-fail rate improved during the pandemic (56.2 vs. before 50.1%). The use of high/moderate potency statins increased among AIS patients (OR 1.26 [1.06-1.48]) and remained unchanged among those with TIA (OR 1.04 [0.83,1.29]). Blood pressure measurement within 90-days of discharge was less frequent during the pandemic (57.8 vs. 89.2%, p < 0.001). Hypertension control decreased among patients with AIS (OR 0.73 [0.60-0.90]) and TIA (OR 0.72 [0.54-0.96]). The average systolic and diastolic blood pressure was 1.9/1.4 mmHg higher during the pandemic than before (p < 0.001). Compared to before, during the pandemic fewer AIS patients had a primary care visit (52.5% vs. 79.8%; p = 0.0001) or a neurology visit (27.9 vs. 41.1%; p = 0.085). Both 30- and 90-day unadjusted all-cause mortality rates were higher in 2020 (3.6% and 6.7%) vs. 2019 (2.9, 5.4%; p = 0.041 and p = 0.006); but these differences were not statistically significant after risk adjustment. Overall quality of care for patients with AIS/TIA did not decline during the COVID-19 pandemic.
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106455
ORCID: 0000-0002-3375-287X
Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
PubMed URL: 35395471
PubMed URL:
Type: Journal Article
Subjects: Ischemic attack
Ischemic stroke
Quality improvement transient
Appears in Collections:Journal articles

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