Abstract Body: 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.