INTRODUCTION: During the COVID-19 pandemic, studies reported less number of hospitalizations for acute stroke and reduction in the use of recanalization treatments. This study analyzes nationwide data on stroke admissions and management in the Czech Republic during the first wave of the COVID-19 pandemic. METHODS: We compared the early COVID-19 pandemic (March-May 2020) with the pre-pandemic period (January-February 2020 and March-May 2019): (a) the National Register of Reimbursed Health Services provided volume of all admissions for subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (IS), and volume of recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]); (b) Registry of Stroke Care Quality provided door-to-needle time (DNT), onset-to-door time (ODT), and stroke severity at admission (National Institutes of Health Stroke Scale, NIHSS) for IS. RESULTS: During the pandemic (March-May 2020), the peak number of COVID-19 patients treated in Czech hospitals was 39 per million. In March-May 2020 versus March-May 2019, hospital admissions decreased as follows: stroke overall by 14% (p < 0.001), IS by 14% (p < 0.001), SAH by 15% (p = 0.07), and ICH by 7% (p = 0.17). The mean age was 74 years versus 74 years (p = 0.33), and 52% versus 51% were men (p = 0.34). The volumes of IVT and MT decreased by 14% (p = 0.001) and 19% (p = 0.01), respectively. The proportions of all IS patients receiving IVT or MT remained unchanged, with, respectively, 17% versus 17% receiving IVT (p = 0.86) and 5% versus 5% receiving MT (p = 0.48). DNT and ODT were 24 versus 25 min (p = 0.58) and 168 versus 156 min (p = 0.23), respectively. NIHSS at admission did not differ (6 vs. 6; p = 0.54). CONCLUSION: Even with a low burden of COVID-19 during the first wave and no change in organization and logistics of stroke services, stroke admissions and volume of recanalization treatments decreased. Public health communication campaigns should encourage people to seek emergency medical care for stroke symptoms during the COVID-19 pandemic.

Department of Internal Medicine Hematology and Oncology University Hospital Brno Brno Czechia

Department of Neurology Charles University Prague 2nd Faculty of Medicine and Motol University Hospital Prague Czechia

Department of Neurology Mayo Clinic Rochester Minnesota USA

Department of Neurology St Anne's University Hospital Brno Czechia

Department of Neurology University Hospital Kralovske Vinohrady and Charles University Prague Prague Czechia

Faculty of Medicine Masaryk University Brno Czechia

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czechia

Institute of Health Information and Statistics of the Czech Republic Prague Czechia

International Clinical Research Center St Anne's University Hospital Brno Czechia

Neurological Department and Stroke Unit Jihlava Hospital Jihlava Czechia

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De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, et al. Reduced rate of hospital admissions for ACS during COVID-19 outbreak in Northern Italy. N Engl J Med. 2020 Jul 2;383((1)):88–9. PubMed PMC

Morelli N, Rota E, Terracciano C, Immovilli P, Spallazzi M, Colombi D, et al. The baffling case of ischemic stroke disappearance from the casualty department in the COVID-19 era. Eur Neurol. 2020;83((2)):213–5. PubMed PMC

Sacco S, Ricci S, Ornello R, Eusebi P, Petraglia L, Toni D, et al. Reduced admissions for cerebrovascular events during COVID-19 outbreak in Italy. Stroke. 2020 Dec;51((12)):3746–50. PubMed PMC

Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung SH, et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020 Aug 13;383((7)):691–3. PubMed

Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 epidemic on stroke care and potential solutions. Stroke. 2020 Jul;51((7)):1996–2001. PubMed PMC

Altersberger VL, Stolze LJ, Heldner MR, Henon H, Martinez-Majander N, Hametner C, et al. Maintenance of acute stroke care service during the COVID-19 pandemic lockdown. Stroke. 2021 May;52((5)):1693–701. PubMed PMC

Nogueira RG, Qureshi MM, Abdalkader M, Martins SO, Yamagami H, Qiu Z, et al. Global impact of COVID-19 on stroke care and intravenous thrombolysis. Neurology. 2021 Mar 25;96((23)):e2824–38. PubMed PMC

Kerleroux B, Fabacher T, Bricout N, Moïse M, Testud B, Vingadassalom S, et al. Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak: decreased activity, and increased care delays. Stroke. 2020 Jul;51((7)):2012–7. PubMed

Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective. Int J Stroke. 2020 Jun;15((4)):361–4. PubMed PMC

Sedova P, Brown RD, Jr, Zvolsky M, Kadlecova P, Bryndziar T, Volny O, et al. Validation of stroke diagnosis in the national registry of hospitalized patients in the Czech Republic. J Stroke Cerebrovasc Dis. 2015 Sep;24((9)):2032–8. PubMed

Sedova P, Brown RD, Zvolsky M, Kadlecova P, Bryndziar T, Kubelka T, et al. Incidence of hospitalized stroke in the Czech Republic: the national registry of hospitalized patients. J Stroke Cerebrovasc Dis. 2017 May;26((5)):979–86. PubMed

Registry of Stroke Care Quality, RES-Q. 2016. [register online https://qualityregistry.eu].FNUSA-ICRC. Accessed 2020 Jul 4.

Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B, et al. Coronavirus pandemic (COVID-19) Published online at OurWorldInData.org. Available from: https://ourworldindata.org/coronavirus. Accessed 2020 December 10. PubMed PMC

Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. J Stroke Cerebrovasc Dis. 2020 Aug;29((8)):104953. PubMed PMC

Gdovinova Z, Vitkova M, Barakova A, Cvopova A. The impact of the COVID-19 outbreak on acute stroke care in Slovakia: data from across the country. Eur J Neurol. 2020 Nov 13 PubMed

Hoyer C, Ebert A, Huttner HB, Puetz V, Kallmünzer B, Barlinn K, et al. Acute stroke in times of the COVID-19 pandemic: a multicenter study. Stroke. 2020 Jul;51((7)):2224–7. PubMed

Bersano A, Kraemer M, Touzé E, Weber R, Alamowitch S, Sibon I, et al. Stroke care during the COVID-19 pandemic: experience from three large European countries. Eur J Neurol. 2020 Sep;27((9)):1794–800. PubMed PMC

Rudilosso S, Laredo C, Vera V, Vargas M, Renú A, Llull L, et al. Acute stroke care is at risk in the era of COVID-19: experience at a comprehensive stroke center in Barcelona. Stroke. 2020 Jul;51((7)):1991–5. PubMed PMC

Tejada Meza H, Lambea Gil Á, Sancho Saldaña A, Martínez-Zabaleta M, Garmendia Lopetegui E, López-Cancio Martínez E, et al. Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain. Eur J Neurol. 2020 Dec;27((12)):2491–8. PubMed PMC

Majidi S, Fifi JT, Ladner TR, Lara-Reyna J, Yaeger KA, Yim B, et al. Emergent Large vessel occlusion stroke during New York city;s COVID-19 outbreak: clinical characteristics and paraclinical findings. Stroke. 2020 Sep;51((9)):2656–63. PubMed PMC

Diegoli H, Magalhães PSC, Martins SCO, Moro CHC, França PHC, Safanelli J, et al. Decrease in hospital admissions for transient ischemic attack, mild, and moderate stroke during the COVID-19 era. Stroke. 2020 Aug;51((8)):2315–21. PubMed PMC

Siegler JE, Zha AM, Czap AL, Ortega-Gutierrez S, Farooqui M, Liebeskind DS, et al. Influence of the COVID-19 pandemic on treatment times for acute ischemic stroke: the Society of Vascular and Interventional Neurology Multicenter Collaboration. Stroke. 2020 Nov 30;52:40–7. PubMed PMC

Katsouras C, Karapanayiotides T, Papafaklis M, Giannopoulos S, Ziakas A, Sianos G, et al. Greater decline of acute stroke admissions compared with acute coronary syndromes during COVID-19 outbreak in Greece: cerebro/cardiovascular implications amidst a second wave surge. Eur J Neurol. 2020 Dec 8 PubMed

Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 Jun;46((6)):1089–98. PubMed PMC

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77((6)):683–90. PubMed PMC

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