Social and clinical vulnerability in stroke and STEMI management during the COVID-19 pandemic: a registry-based study.
BMJ Open
; 14(1): e073933, 2024 01 03.
Article
in En
| MEDLINE
| ID: mdl-38171619
ABSTRACT
OBJECTIVE:
This study aims to evaluate whether the first wave of the COVID-19 pandemic resulted in a deterioration in the quality of care for socially and/or clinically vulnerable stroke and ST-segment elevation myocardial infarction (STEMI) patients.DESIGN:
Two cohorts of STEMI and stroke patients in the Aquitaine neurocardiovascular registry.SETTING:
Six emergency medical services, 30 emergency units, 14 hospitalisation units and 11 catheterisation laboratories in the Aquitaine region in France.PARTICIPANTS:
This study involved 9218 patients (6436 stroke and 2782 STEMI patients) in the neurocardiovascular registry from January 2019 to August 2020. PRIMARY OUTCOMEMEASURES:
Care management times in both cohorts first medical contact-to-procedure time for the STEMI cohort and emergency unit admission-to-imaging time for the stroke cohort. Associations between social (deprivation index) and clinical (age >65 years, neurocardiovascular history) vulnerabilities and care management times were analysed using multivariate linear mixed models, with an interaction on the time period (pre-wave, per-wave and post-first COVID-19 wave).RESULTS:
The first medical contact procedure time was longer for elderly (p<0.001) and 'very socially disadvantaged' (p=0.003) STEMI patients, with no interaction regarding the COVID-19 period (age, p=0.54; neurocardiovascular history, p=0.70; deprivation, p=0.64). We found no significant association between vulnerabilities and the admission imaging time for stroke patients, and no interaction with respect to the COVID-19 period (age, p=0.81; neurocardiovascular history, p=0.34; deprivation, p=0.95).CONCLUSIONS:
This study revealed pre-existing inequalities in care management times for vulnerable STEMI and stroke patients; however, these inequalities were neither accentuated nor reduced during the first COVID-19 wave. Measures implemented during the crisis did not alter the structured emergency pathway for these patients. TRIAL REGISTRATION NUMBER NCT04979208.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Stroke
/
Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
/
COVID-19
Type of study:
Prognostic_studies
Limits:
Aged
/
Humans
Language:
En
Journal:
BMJ Open
Year:
2024
Type:
Article
Affiliation country:
France