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Trends of ischemic stroke admission during two years of COVID-19 pandemic: A retrospective cross-sectional study at a tertiary hospital in Indonesia

  • Pipit Mei Sari ,
  • Atika Mira Agniana ,
  • Mohammad Saiful Ardhi ,

Abstract

Introduction: There is no much information on how admission rates of non-coronavirus disease 2019 (COVID-19) diseases altered after two years of COVID-19 pandemic. The aim of this study was to determine the pattern of ischemic stroke admission rates within the two years of the COVID-19 pandemic in Indonesia.

Method: A cross-sectional retrospective study investigated the admissions data of ischemic stroke was conducted at a tertiary hospital in Indonesia between January 2019 and December 2021. Ischemic stroke patients aged over 18 years old were identified using the ICD-10 I63 code. The data was accumulated every month and analyzed descriptively. We also analyzed the admissions data of ischemic stroke patients with COVID-19 and in-hospital mortality was calculated.

Results: There were 2,710 ischemic stroke patients treated between 2019 and 2021 of which the number decreased from 1535 patients in 2019 to 730 in 2020 and only 445 cases in 2021. During 2019-2021, a total of 777 patients (28.67%) died during hospitalization; the most was in 2021 (33.3%). There is a consistent downward trend in ischemic stroke admissions during the COVID-19 pandemic with the monthly average admissions decreased 52.4% in 2020 compared to 2019 and 38.9% in 2021. Despite that, the mortality rate of ischemic stroke patients in the hospital increased from 26.5% in 2019 to 30.4% in 2020, and 33.3% in 2021. The number of ischemic stroke patients coinfected with COVID-19 was 3.5% (26/730) in 2020 and 8.1% (36/445) in 2021. Of all 62 ischemic stroke cases with COVID-19 in 2020-2021, 36 died yielded 58.1% in-hospital mortality rate.

Conclusion: The decreased admissions and the increased mortality rate of ischemic stroke patients in particular those coinfected with COVID-19 during the first two years of pandemic should draw government attention to the necessity of improving stroke managements in Indonesia.

References

  1. Nogueira RG, Abdalkader M, Qureshi MM, et al. Global impact of COVID-19 on stroke care. Int J Stroke. 2021;16(5):573-584. doi:10.1177/1747493021991652
  2. Kwok CS, Gale CP, Kinnaird T, et al. Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction. Heart. 2020;106(23):1805-1811. doi:10.1136/heartjnl-2020-317650
  3. Seiffert M, Brunner FJ, Remmel M, et al. Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims. Clin Res Cardiol. 2020;109(12):1540-1548. doi:10.1007/s00392-020-01723-9
  4. Di Liberto IA, Pilato G, Geraci S, et al. Impact on hospital admission of ST-elevation myocardial infarction patients during coronavirus disease 2019 pandemic in an Italian Hospital. J Cardiovasc Med (Hagerstown). 2020;21(9):722-724. doi:10.2459/JCM.0000000000001053
  5. Lantelme P, Couray Targe S, Metral P, et al. Worrying decrease in hospital admissions for myocardial infarction during the COVID-19 pandemic. Arch Cardiovasc Dis. 2020;113(6-7):443-447. doi:10.1016/j.acvd.2020.06.001
  6. Lange SJ, Ritchey MD, Goodman AB, et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions — United States, January–May 2020. Am J Transplant. 2020;20(9):2612-2617. doi:10.1111/ajt.16239
  7. Qureshi AI, Siddiq F, French BR, et al. Effect of COVID-19 Pandemic on Mechanical Thrombectomy for Acute Ischemic Stroke Treatment in United States. J Stroke Cerebrovasc Dis. 2020;29(10):105140. doi:10.1016/j.jstrokecerebrovasdis.2020.105140
  8. Markus HS, Brainin M. COVID-19 and stroke—A global World Stroke Organization perspective. Int J Stroke. 2020;15(4):361-364. doi:10.1177/1747493020923472
  9. Tavanaei R, Yazdani KO, Akhlaghpasand M, Zali A, Oraee-Yazdani S. Changed pattern of hospital admission in stroke during COVID-19 pandemic period in Iran: a retrospective study. Neurol Sci. 2021;42(2):445-453. doi:10.1007/s10072-020-05030-z
  10. Gubernur JT. Penetapan Rumah Sakit Rujukan Penyakit Corona Virus Disease 2019 (COVID-19) Di Jawa Timur.; 2020. https://dinkes.jatimprov.go.id/userfile/dokumen/KEPGUG 99 RS RUJUKAN JATIM TERBARU.pdf
  11. McCormick N, Bhole V, Lacaille D, Avina-Zubieta JA. Validity of diagnostic codes for acute stroke in administrative databases: A systematic review. PLoS One. 2015;10(8). doi:10.1371/journal.pone.0135834
  12. Khaerunnisa R, Aula Rumana N, Yulia N, Fannya P. Gambaran Karakteristik Pasien Covid-19 di Rumah Sakit Mekar Sari Bekasi Tahun 2020-2021. J Manaj Inf Kesehat Indones. 2022;10(1):64-72. doi:10.33560/jmiki.v10i1.390
  13. Stöhr E, Aksoy A, Campbell M, et al. Hospital admissions during Covid-19 lock-down in Germany: Differences in discretionary and unavoidable cardiovascular events. PLoS One. 2020;15(11 November):1-10. doi:10.1371/journal.pone.0242653
  14. Hasibul Hasan ATM, Das SC, Islam MS, et al. Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh. PLoS One. 2021;16(1 January):1-9. doi:10.1371/journal.pone.0240385
  15. Kemenkes RI. Protocol for the Management of Corona Virus Disease 2019 (Covid-19) Body Studying and Burial. Decree of the Minister of Health of the Republic of Indonesia. 2021;4834(01.07):1-12. https://tumj.tums.ac.ir/article-1-11063-fa.html
  16. Kemenkes RI. Decree of the Minister of Health of the Republic of Indonesia Number HK.01.07/Menkes/4638/2021 concerning Technical Guidelines for the Implementation of Vaccination in the Context of Combating the Corona Virus Disease 2019 (Covid-19) Pandemic. Decree of the Minister of Health of the Republic of Indonesia. 2021;2019(2):1-4. http://www.jurnalrespirologi.org/index.php/jri/article/view/101
  17. Kemenkes RI. Weekly Update COVID-19 TRACING-TESTING. Indonesian COVID-19 Week Overview. Published online 2021:7-13.
  18. Hassan W, Kazmi SK, Tahir MJ, Ullah I, Royan HA, Fahriani M, et al. Global acceptance and hesitancy of COVID-19 vaccination: A narrative review. Narra J. 2021; 1:e57.
  19. Ardhi MS, Islam MS. Relationship between high sensitivity tnf-α with clinical outcome during admission in acute ischemic stroke. Indian J Forensic Med Toxicol. 2021;15(1):1305-1308. doi:10.37506/ijfmt.v15i1.13595
  20. Rachmawati M, Sugianto P, Wardhani RIL. LDL Level in Ischaemic Stroke Patients at Dr. Soetomo General Hospital Surabaya. Biomol Heal Sci J. 2019;2(1):41. doi:10.20473/bhsj.v2i1.12743
  21. Erawantini F, Karimah RN. Early Warning Systems (E-Wars) Design for Early Detection of Stroke Incidence. Folia Medica Indones. 2018;54(2):136. doi:10.20473/fmi.v54i2.8864
  22. Sarengat R, Islam MS, Ardhi MS. Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19. Narra J. 2021; 1:e50.
  23. Ong C Ter, Sung SF, Wong YS, et al. Risk factors for in-hospital mortality among ischemic stroke patients in southern Taiwan. Int J Gerontol. 2016;10(2):86-90. doi:10.1016/j.ijge.2014.06.013
  24. Mohammed AS, Degu A, Woldekidan NA, Adem F, Edessa D. In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis. SAGE Open Med. 2021;9:205031212110367. doi:10.1177/20503121211036789
  25. Smith EE, Shobha N, Dai D, et al. Risk score for in-hospital ischemic stroke mortality derived and validated within the get with the guidelines-stroke program. Circulation. 2010;122(15):1496-1504. doi:10.1161/CIRCULATIONAHA.109.932822
  26. Gebreyohannes EA, Bhagavathula AS, Abebe TB, Seid MA, Haile KT. In-Hospital Mortality among Ischemic Stroke Patients in Gondar University Hospital: A Retrospective Cohort Study. Stroke Res Treat. 2019;2019. doi:10.1155/2019/7275063
  27. Uy J, Siy Van VT, Ulep VG, Bayani DB, Walker D. The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020. Lancet Reg Heal - West Pacific. 2022;18:100310. doi:10.1016/j.lanwpc.2021.100310
  28. Bodilsen J, Nielsen PB, Søgaard M, et al. Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: Nationwide population-based cohort study. BMJ. 2021;373. doi:10.1136/bmj.n1135
  29. Kalanj K, Marshall R, Karol K, Tiljak MK, Orešković S. The Impact of COVID-19 on Hospital Admissions in Croatia. Front Public Heal. 2021;9(March 2020):1-11. doi:10.3389/fpubh.2021.720948
  30. Nourazari S, Davis SR, Granovsky R, et al. Decreased hospital admissions through emergency departments during the COVID-19 pandemic. Am J Emerg Med. 2021;42(January):203-210. doi:https://doi.org/10.1016/j.ajem.2020.11.029
  31. Huang ZX, Gu HQ, Yang X, Wang CJ, Wang Y, Li Z. Risk factors for in-hospital mortality among acute ischemic stroke patients in China: a nationwide prospective study. Neurol Res. 2021;43(5):387-395. doi:10.1080/01616412.2020.1866356
  32. Harrison SL, Fazio-Eynullayeva E, Lane DA, Underhill P, Lip GYH. Higher Mortality of Ischaemic Stroke Patients Hospitalized with COVID-19 Compared to Historical Controls. Cerebrovasc Dis. 2021;50(3):326-331. doi:10.1159/000514137
  33. Dmytriw AA, Dibas M, Phan K, et al. Acute ischaemic stroke associated with SARS-CoV-2 infection in North America. J Neurol Neurosurg Psychiatry. 2022;93(4):360-368. doi:10.1136/jnnp-2021-328354
  34. Fahriani M, Ilmawan M, Fajar JK, Maliga HA, Frediansyah A, Masyeni S, et al. Persistence of long COVID symptoms in COVID-19 survivors worldwide and its potential pathogenesis-a systematic review and meta-analysis. Narra J. 2021; 1:e36.
  35. Luo W, Liu X, Bao K, Huang C. Ischemic stroke associated with COVID-19: a systematic review and meta-analysis. J Neurol. 2022;269(4):1731-1740. doi:10.1007/s00415-021-10837-7
  36. Tini K, Samatra IDPGP, Wiryadana KA, Supadmanaba IGP. Clinical profile of patients with cerebrovascular disease at Stroke Unit, Sanglah General Hospital, Denpasar, Bali. Bali Med J. 2020;9(1):129. doi: http://dx.doi.org/10.15562/bmj.v9i1.1665

How to Cite

Sari, P. M., Agniana, A. M. ., & Ardhi, M. S. (2022). Trends of ischemic stroke admission during two years of COVID-19 pandemic: A retrospective cross-sectional study at a tertiary hospital in Indonesia. Bali Medical Journal, 11(2), 864–869. https://doi.org/10.15562/bmj.v11i2.3498

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Pipit Mei Sari
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Atika Mira Agniana
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Mohammad Saiful Ardhi
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