Evidence map›Paper›PMID 35395471›Full record

ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2022

Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic.

Laura J Myers, Anthony J Perkins, Monique F Kilkenny, Dawn M Bravata

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
1.1field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Laura J MyersDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), United States; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H 1481 West 10th Street, Indianapolis, IN 46202, United States; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: Laura.Myers2@va.gov.
Anthony J PerkinsDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), United States; Department of Biostatistics, Indiana University School of Medicine, IUPUI, Indianapolis, IN, United States.
Monique F KilkennyStroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
Dawn M BravataDepartment of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), United States; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, HSR&D Mail Code 11H 1481 West 10th Street, Indianapolis, IN 46202, United States; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Emergency Medicine, Indiana University School of Medicine; Indianapolis, IN, United States; Regenstrief Institute, Indianapolis, IN, United States; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States.
Health Services Research & Development · USFlorey Institute of Neuroscience and Mental Health · AURegenstrief Institute · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeHospitalizations for acute ischemic stroke (AIS) and transient ischemic attack (TIA) decreased during the COVID-19 pandemic. We compared the quality of care and outcomes for patients with AIS/TIA before vs. during the COVID-19 pandemic across the United States Department of Veterans Affairs healthcare system.

methodsThis retrospective cohort study compared AIS/TIA care quality before (March-September 2019) vs. during (March-September 2020) the pandemic. Electronic health record data were used to identify patient characteristics, quality of care and outcomes. The without-fail rate was a composite measure summarizing whether an individual patient received all of the seven processes for which they were eligible. Mixed effects logistic regression modeling was used to assess differences between the two periods.

resultsA decrease in presentations occurred during the pandemic (N = 4360 vs. N = 5636 patients; p = 0.003) and was greater for patients with TIA (-30.4%) than for AIS (-18.7%). The without-fail rate improved during the pandemic (56.2 vs. before 50.1%). The use of high/moderate potency statins increased among AIS patients (OR 1.26 [1.06-1.48]) and remained unchanged among those with TIA (OR 1.04 [0.83,1.29]). Blood pressure measurement within 90-days of discharge was less frequent during the pandemic (57.8 vs. 89.2%, p < 0.001). Hypertension control decreased among patients with AIS (OR 0.73 [0.60-0.90]) and TIA (OR 0.72 [0.54-0.96]). The average systolic and diastolic blood pressure was 1.9/1.4 mmHg higher during the pandemic than before (p < 0.001). Compared to before, during the pandemic fewer AIS patients had a primary care visit (52.5% vs. 79.8%; p = 0.0001) or a neurology visit (27.9 vs. 41.1%; p = 0.085). Both 30- and 90-day unadjusted all-cause mortality rates were higher in 2020 (3.6% and 6.7%) vs. 2019 (2.9, 5.4%; p = 0.041 and p = 0.006); but these differences were not statistically significant after risk adjustment.

conclusionsOverall quality of care for patients with AIS/TIA did not decline during the COVID-19 pandemic.

Indexed as

COVID-19Ischemic Attack, TransientIschemic StrokeStrokeHumansPandemicsQuality of Health CareRetrospective StudiesUnited StatesIschemic attackIschemic strokeMortalityOutcomesQuality improvement transientReadmission

Identifiers

PMID35395471
PMCPMC8983051
OpenAlexW4223597155

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.