The impact of the COVID-19 epidemic on dutch acute stroke care-a nationwide study

Background and Aims: The COVID-19 epidemic puts stress on healthcare systems worldwide. This study aims to illustrate the impact of the COVID-19 epidemic on Dutch acute stroke care in 2020. Methods: Patients with acute ischemic stroke (AIS) registered in the Dutch Acute Stroke Audit since 2015 were included (n=192758). The first and second surge of the COVID-19 epidemic were compared to corresponding periods in 2019;variables were checked on occurring trends since 2015. Results: There were 9% fewer AIS-admissions during the first surge (5682 vs. 6256 p<0.001) and 2% fewer admissions during the second surge (8426 vs. 8600 p 0.185) compared to the reference periods. The percentage of patients treated with intravenous thrombolysis declined (first surge: -0.2%;second: -0.9%), while the percentage of patients treated with endovascular thrombectomy increased (first surge: +0.7%;second: +0.5%). This increase in both surges was less than expected based on the trend since 2015. Median door-to-needle time was extended in the first (27 vs. 25 minutes, p 0.001) and second surge (27 vs. 26 minutes, p 0.014), but within limits of an increasing trend. Median doorto-groin time (DGT) was lengthened in the first surge (59 vs. 52 minutes p 0.002). The second surge showed shortened DGT (53 vs. 57 minutes p 0.070), for referred EVT-patients (27 vs. 35 minutes, p 0.001). Conclusions: Impact of the COVID-19 epidemic on stroke care was mainly present in the first surge, with decreased AIS-admissions and lengthened DGT. Stroke campaigns and adjustments in workflows can nullify this impact in times of prolonged crisis.