August 26, 2020

Fewer patients seeking stroke care during COVID-19

Kaiser Permanente study supports previous research showing that patients may be avoiding urgent care due to fear of COVID-19 exposure.

Emergency physicians saw fewer patients with stroke symptoms in the early months of the COVID-19 pandemic.

Emergency physicians at Kaiser Permanente in Northern California saw fewer patients with stroke symptoms in the early months of the COVID-19 pandemic than they typically do, new research shows. The study, published online in Stroke, supports previous research that suggests fear of contracting the novel coronavirus in a medical setting may have kept people from seeking critically needed medical care.

Mai N. Nguyen-Huynh, MD
Mai N. Nguyen-Huynh, MD

“If someone doesn’t come to the emergency department within 24 hours of first experiencing symptoms, they miss the window in which they might be able to have a drug that can break up the clot or have the clot removed,” said the study’s lead author, Mai N. Nguyen-Huynh, MD, a research scientist at the Kaiser Permanente Division of Research.

Patients who come to a Kaiser Permanente Northern California emergency department with stroke symptoms are evaluated by neurologists with the Stroke EXPRESS program. Dr. Nguyen-Huynh and her colleagues compared the volume of patients evaluated by neurologists after shelter-in-place orders went into effect in the San Francisco Bay Area in March 2020 to the volume evaluated in both 2019 and the first 11 weeks of 2020. In 2019, the weekly average of patients evaluated ranged from 120 to 160; from January 1 to March 14, 2020, the weekly average was 136. After March 15, 2020, the weekly average dropped to 98 patients and it remained low through May 9, when California began to reopen.

The characteristics of the patients seen before and after the pandemic also differed. The patients evaluated from March 15 through May 9 were more likely to have had a moderate or severe stroke, to have a blockage in one of the major arteries in the brain, and to have been taken to the emergency room by ambulance than were those seen from January 2019 to March 14, 2020. They were also less likely to have other health problems, such as diabetes or lung disease.

“We thought that people with additional medical problems who were having stroke symptoms might have feared coming to the hospital because they had heard that people with these health problems had worse outcomes if they became infected with COVID-19,” said Dr. Nguyen-Huynh. “Our study found these people with additional health problems were in fact less likely to come in.”

According to the American Heart Association, each year more than 795,000 people in the United States have a stroke, resulting in about 150,000 deaths. About 87% of all strokes are ischemic strokes that block blood flow from getting to the brain. As a result, stroke is a leading cause of long-term disability. For Black people, the risk of having a first stroke is nearly twice as high as it is for white people. Black people also have the highest death rate due to stroke.

“It is important for individuals experiencing stroke symptoms to get to the hospital as quickly as they can,” said study coauthor Stephen Sidney, MD, MPH, a senior research scientist and the director of Research Clinics at the Division of Research. “Everybody should be educated about the FAST acronym that helps detect stroke warning signs — F: Face drooping, A: Arm weakness, S: Speech difficulty, T: Time to call 911.”