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More accurate estimates of stroke risk for patients hospitalized for COVID-19 infection were obtained from a large enrollment study of the American Heart Association.
Findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry, including more than 20,000 American adults hospitalized for COVID-19 from March to November 2020, are: Ischemic stroke 0.75%.
This is lower than previous estimates of ischemic stroke risk from severe COVID-19 infection, but nonetheless influenza Or Sepsis..
Double the risk of in-hospital death
The results also show that patients who had an ischemic stroke during hospitalization with COVID-19 were twice as likely to die as those who did not.
“These findings suggest that COVID-19 may increase the risk of stroke, but the exact mechanism of this is still unknown,” said a Cardiology Fellow at the University of Washington in Seattle. Principal Research Author Saate S. Shakil, MD, said. “As the pandemic continued, we found that the coronavirus was not just a respiratory disease, but a vascular disease that could affect many organ systems,” she added.
The findings were presented at the Virtual International Stroke Conference (ISC) 2021 on March 19.
Shakil explained that when the COVID-19 pandemic first occurred, there were reports of more frequent ischemic strokes in patients hospitalized with this infection than expected. Previous studies have estimated stroke rates for COVID-19 patients to be between 0.9% and 2%, and she said the largest study investigating this included 8,000 patients.
The current findings are from a much larger database, with current reports involving 21,073 patients admitted with COVID-19 between March and November 2020.
The results showed that 160 of these patients had an ischemic stroke while hospitalized for COVID-19. This corresponds to a percentage of 0.75%.
Patients with ischemic stroke were older (mean 65 years) and more likely to be male (63% vs. 54%) than those admitted with COVID without stroke (61 years).
Patients who had a stroke were also more likely to have comorbidities known to increase their risk of stroke. High blood pressure, Atrial fibrillation, Diabetes, and a history of existing cerebrovascular disease or stroke. “This is not surprising at all, as these are known risk factors for experiencing ischemic stroke regardless of COVID-19 infection.”
The findings show that 44% of patients with ischemic stroke also had it. Type 2 diabetes Compared to about one-third of patients without stroke.
Hypertension was “extremely prevalent” and occurred in 60% of all hospitalized COVID patients who did not have a stroke and 80% of those who had a stroke, Shakil said.
Atrial fibrillation was found in 18% of COVID patients with ischemic stroke, compared to 9% of patients without stroke.
Stroke patients were twice as likely to be severely ill, as evidenced by their admission and need for intensive care units. Mechanical ventilation Or, dialysis compared to those who did not have a stroke, Shakil reported.
In addition, people with ischemic stroke have twice the length of hospital stay (20 days) compared to 10 days without stroke, double the mortality rate, and 16 in-hospital mortality rates. It was 37% compared to humans. % For those who did not have a stroke.
Black patients have the highest risk of stroke
Analyzing the findings by race / ethnicity revealed significant racial disparities, Shakil observed, among COVID-19 patients with ischemic stroke compared to the overall composition of the registry. Non-Hispanic black patients were overrated in. “Interestingly, this trend seems to be reversed among Hispanic patients,” she added.
The number of non-Hispanic Caucasian patients with ischemic stroke was similar to the number of overall representations in the registry.
Hispanic patients had the lowest risk of ischemic stroke, 0.52%. The risk for non-Hispanic whites was 0.75% and the risk for non-Hispanic blacks was 0.91%. Non-Hispanic blacks made up 26% of the registry, but 31% of those who had an ischemic stroke.
Shakir said he didn’t know what to do with the data showing that Hispanics were at low risk. “We will continue to consider it.”
“These results are for all visitors in each racial group, and the results have not been adjusted for baseline demographics or comorbidities,” Shakil warned, researchers warned that the factors behind these disparities. He added that he plans to do further analysis to understand.
“We know that the COVID-19 pandemic has a disproportionate effect on the color community, but our study suggests that African Americans may still be at high risk of ischemic stroke after being infected with the virus. It suggests that there is sex, “Shakil said. “Stroke can have catastrophic consequences on its own, and recovery from COVID-19 is often a difficult path for survivors. Together, it is a serious sacrifice for patients suffering from both conditions. Can be forced. “
“It is more important than ever to control the spread of COVID-19 through public health interventions and widespread vaccine distribution,” she added.
Dr. Louise McCullough, MD, Moderator of the ISC Press Conference on the study, Memorial Hermann Hospital-Texas Medical Center, Dean of Neurology in Houston, and the ISC Meeting Chair said the study showed a number of strengths. ..
“It’s very impressive to be able to get these data in such a short amount of time,” she said. “This demonstrates the value of having such a large dataset.”
McCullough said the effects of COVID on stroke may not be limited to actual length of stay. “Millions of people have been infected and have recovered from this infection. What is the problem? [this] Will these people get sick in the next 10 years? Will chronic long-distance syndrome occur, and will it affect the incidence of dementia and vascular disease in the future?
“What is this? [that] “You can see this by following individuals in these datasets. If COVID disappears next year, it won’t really disappear because of the large number of people affected,” she adds. I did.
Mitchell Elkind, MD, professor of neurology at Columbia University in New York City and chairman of the American Heart Association / American Stroke Association, said that infections such as pneumonia and urinary tract infections are common complications of stroke. Patients with infections who also pointed out that there is evidence of stroke appear to be at increased risk of developing post-stroke dementia and cognitive decline.
“Something about a stroke affects your immune system, which seems to lead to a secondary degeneration problem in the brain, which can be exacerbated if you throw an infection on it. There is sex, “he said. “COVID could be a model for addressing some of these types of questions.”
International Stroke Conference (ISC) 2021. Latest Summary 12. Published March 19, 2021.
This study was funded by the American Heart Association. Shakil does not disclose any relevant financial relationships.
