American Heart Association Releases Results on COVID-19 and Stroke Characteristics, Prevalence

Saate S. Shakil, MD

Results from the American Heart Association (AHA) COVID-19 Cardiovascular Disease Registry (CVD) found that COVID-19 patients with stroke were older and more likely to be men than those without stroke.¹

Led by Saate S. Shakil, MD, cardiology fellow, University of Washington, the data presented at the American Stroke Association's International Stroke Conference (ISC) 2021, March 17–19, included over 20,000 patients with COVID-19 who were admitted at 104 hospitals with virologic diagnosis between March and November 2020.

A total of 281 patients (1.4%) with COVID-19 had a stroke confirmed by diagnostic imaging during hospitalization, 148 (52.7%) of which experienced ischemic stroke. Transient ischemic attack (TIA) occurred in 7 patients (2.5%), with the remaining 127 patients (45.2%) experiencing bleeding stroke or unspecified type of stroke.

"These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown.” Shakil said in a statement.² “As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems.”

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Other notable findings showed that stroke was more prevalent in males (64%) and more likely in older (average age, 65) patients than those without stroke (average age, 61). Furthermore, 44% of patients who had an ischemic stroke also had Type 2 diabetes compared to about one-third of patients without stroke. High blood pressure was also observed in 80% of ischemic stroke patients compared to 58% for those without stroke.

Atrial fibrillation was observed in 18% and 9% of patients with and without ischemic stroke, respectively. Shakil and colleagues also found that patients with ischemic stroke stayed, on average, 22 days in the hospital, whereas those without stroke spent an average of 10 days. In-hospital deaths were twice as high among patients with stroke (37%) compared to patients without stroke (16%).

The effects of the virus were also more prominent among Black Americans. Despite accounting for 27% of the patients in the registry for analysis, 31% of ischemic stroke cases were among Black patients.

"We know the COVID-19 pandemic has disproportionately affected communities of color, but our research suggests Black Americans may have higher risk of ischemic stroke after contracting the virus as well,” Shakil added. “Stroke on its own can have devastating consequences and recovering from COVID-19 is often a difficult path for those who survive. Together, they can exact a significant toll on patients who have had both conditions.”

The associations of stroke and COVID-19 have been well documented throughout the pandemic. In July 2020 a case-series study comparing severity of strokes in patients with and without COVID-19 suggested that ischemic strokes associated with the virus are more severe with worse functional outcomes and higher mortality rates than non-COVID-19 ischemic strokes.³

In a 1:1 matched sample of 336 patients with COVID-19 and without COVID-19, the median National Institute of Health Stroke Scale (NIHSS) score was higher in patients with COVID-19 (10; interquartile range (IQR), 4-18) compared to those without (6; IQR, 3-14) for an odds ratio (OR) of 1.69 (95% CI, 1.08-2.65; P = .03). The study was led by George Ntaios, MD, MSc, PhD, assistant professor, University of Thessaly, Greece.

For more coverage of ISC 2021, click here.

REFERENCE

1. Shakil S, Emmons-Bell S, Rutan C, et al. Stroke among patients hospitalized with COVID-19 I the United States: Results from the AHA COVID-19 Cardiovascular Disease Registry. Presented at International Stroke Conference 2021; March 17–19. Abstract LB 12

2. Stroke risk higher than expected among COVID-19 patients. News release. March 19, 2020. Accessed March 19, 2021. https://newsroom.heart.org/news/stroke-risk-higher-than-expected-among-covid-19-patients

3. Ntaios G, Michel P, Georgiopoulos G, et al. Characteristics and outcomes in patients with COVID-19 and acute ischemic stroke. Stroke. Published July 8, 2020. doi: 10.1161/STROKEAHA.120.031208