Stroke care in the United Kingdom before, during, and after the COVID-19 lockdowns: A retrospective nationwide cohort study

TY - JOUR

T1 - Stroke care in the United Kingdom before, during, and after the COVID-19 lockdowns

T2 - A retrospective nationwide cohort study

AU - Hbid, Youssef

AU - Stanley, Kaili

AU - Wolfe, Charles D. A.

AU - Bhalla, Ajay

AU - James, Martin

AU - Douiri, Abdel

AU - SSNAP collaboration

N1 - Publisher Copyright: © 2025 Hbid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2025/9/2

Y1 - 2025/9/2

N2 - BACKGROUND AND AIM: The COVID-19 pandemic imposed significant pressures on healthcare services such as stroke care. This study aimed to assess the quality of stroke care and, outcome before, during and post lockdown.METHODS: Nationwide registry-based cohort study of patients with acute stroke admitted to hospitals in England, Wales, and Northern Ireland were analyzed. This included 114 hospitals for study cohorts of 261,451 in the pre-pandemic control period (01/04/2017-25/03/2020). The exposures studied include 16,843 during the first lockdown (26/03/2020-23/06/2020), 48,004 during the second lockdown (05/11/2020-17/05/2021), and 82,732 post-lockdowns (18/07/2021-30/06/2022). Logistic regression was used to compare odds of receiving aspects of acute stroke care across pandemic periods compared to the pre-pandemic period. Survival after stroke was assessed using restricted mean survival time (RMST) analysis, with models adjusted for age, sex, and stroke severity.RESULTS: Admission to a stroke unit within 4-hours increased by 8% during the first lockdown but fell by 7% in the second lockdown and remained lower post-pandemic. During the first lockdown, brain imaging within 1-hour increased by 3%, but was not maintained thereafter. Stroke multidisciplinary access increased during the first lockdown but decreased in subsequent periods. Access to thrombectomy sequentially increased across time periods; by 40% during first lockdown (adjusted Odd-Ratio: 1.4; 95% CI:1.24-1.58), second lockdown (aOR: 1.77; 1.66-1.92), and 2-folds post-lockdown (aOR: 2.03; 1.92-2.15). Thrombolysis rates fell during the pandemic and did not recover post-pandemic. Although proportion of patients discharged with good recovery did not alter, 7-day mortality increased by 10% (hazard ratio: 1.10, 1.04-1.18) in the first lockdown period but improved thereafter.CONCLUSION: This nationwide population data showed unprecedented levels of pressure from the COVID-19 pandemic which have had an enduring effect on the quality of hospital stroke care and patient outcomes. Stroke care has not fully recovered post-pandemic period suggesting limited resilience.

AB - BACKGROUND AND AIM: The COVID-19 pandemic imposed significant pressures on healthcare services such as stroke care. This study aimed to assess the quality of stroke care and, outcome before, during and post lockdown.METHODS: Nationwide registry-based cohort study of patients with acute stroke admitted to hospitals in England, Wales, and Northern Ireland were analyzed. This included 114 hospitals for study cohorts of 261,451 in the pre-pandemic control period (01/04/2017-25/03/2020). The exposures studied include 16,843 during the first lockdown (26/03/2020-23/06/2020), 48,004 during the second lockdown (05/11/2020-17/05/2021), and 82,732 post-lockdowns (18/07/2021-30/06/2022). Logistic regression was used to compare odds of receiving aspects of acute stroke care across pandemic periods compared to the pre-pandemic period. Survival after stroke was assessed using restricted mean survival time (RMST) analysis, with models adjusted for age, sex, and stroke severity.RESULTS: Admission to a stroke unit within 4-hours increased by 8% during the first lockdown but fell by 7% in the second lockdown and remained lower post-pandemic. During the first lockdown, brain imaging within 1-hour increased by 3%, but was not maintained thereafter. Stroke multidisciplinary access increased during the first lockdown but decreased in subsequent periods. Access to thrombectomy sequentially increased across time periods; by 40% during first lockdown (adjusted Odd-Ratio: 1.4; 95% CI:1.24-1.58), second lockdown (aOR: 1.77; 1.66-1.92), and 2-folds post-lockdown (aOR: 2.03; 1.92-2.15). Thrombolysis rates fell during the pandemic and did not recover post-pandemic. Although proportion of patients discharged with good recovery did not alter, 7-day mortality increased by 10% (hazard ratio: 1.10, 1.04-1.18) in the first lockdown period but improved thereafter.CONCLUSION: This nationwide population data showed unprecedented levels of pressure from the COVID-19 pandemic which have had an enduring effect on the quality of hospital stroke care and patient outcomes. Stroke care has not fully recovered post-pandemic period suggesting limited resilience.

KW - Humans

KW - COVID-19/epidemiology

KW - Male

KW - Female

KW - Stroke/therapy

KW - Aged

KW - Retrospective Studies

KW - Middle Aged

KW - United Kingdom/epidemiology

KW - Aged, 80 and over

KW - SARS-CoV-2/isolation & purification

KW - Registries

KW - Pandemics

KW - Hospitalization

UR - https://www.scopus.com/pages/publications/105014738253

U2 - 10.1371/journal.pone.0330903

DO - 10.1371/journal.pone.0330903

M3 - Article

C2 - 40892745

SN - 1932-6203

VL - 20

JO - PLoS ONE

JF - PLoS ONE

IS - 9

M1 - e0330903

ER -