The full picture of COVID-19’s effects on the continuum of stroke care is just beginning to emerge, but two Cizik School of Nursing at UTHealth Houston nurse scientists collaborated on studies that reveal potentially negative impacts, from hospital admission through rehabilitation.
Associate Professor Jennifer E.S. Beauchamp, PhD, RN, FAAN, and Assistant Professor Seema Aggarwal, PhD, AGNP-C, contributed to interdisciplinary research studies on stroke care during the pandemic. Beauchamp’s group looked at admissions and inpatient treatment, while Aggarwal’s assessed the effects of delayed admission to inpatient rehabilitation. Both faculty are also members of the UTHealth Houston Institute for Stroke and Cerebrovascular Disease.
Fewer stroke admissions
In a study led by UTHealth Houston’s stroke fellow graduate Sujan Reddy, MD, Beauchamp and other researchers conducted a meta-analysis of published findings worldwide and analyzed specific data from Memorial Hermann Health System in Houston.
“It’s been well known in the literature that, for whatever reason, there have been fewer hospital admissions for stroke in the time of COVID-19,” said Beauchamp, the Nancy B. Willerson Distinguished Professor in Nursing. “We don’t think that’s because strokes have gone away.” In fact, COVID-19 is known to cause stroke events in a subset of younger patients.
One likely explanation for fewer admissions of patients who experienced milder strokes is the fear of acquiring COVID-19, and lockdowns may have affected access to transportation and care for some. However, Beauchamp indicated more research, including patient interviews, is needed to verify causes for the trend.
“In the future, when issuing statewide or national mandates, it is crucial to simultaneously incorporate public awareness to encourage patients to seek timely medical care for emergent conditions like stroke and myocardial infarctions, which are treatable but time-sensitive,” Beauchamp said. “Taking the treatment to the patient with mobile stroke units can be a defining strategy during such crises in the future.”
The study to which Beauchamp contributed found that door-to-treatment times increased, as did the length of hospital stays for stroke patients.
Aggarwal’s work picked up where Beauchamp’s left off. Aggarwal worked with UTHealth Houston Stroke Institute staff researching inpatient rehabilitation for stroke care based on data from TIRR Memorial Hermann. Leading the study was Dorothea Parker, BSN, RN, a research nurse in the UTHealth Houston Stroke Institute.
“The admission rate dropped by 50% for inpatient rehabilitation,” Aggarwal noted.
Even under normal circumstances, only a fraction of patients experiencing stroke receives inpatient rehabilitation, with a lack of adequate insurance coverage being an obstacle for some. Additional exacerbating factors during the pandemic included reduced capacity at rehab facilities due to the need for social distancing and delays in treating COVID-positive patients, Aggarwal said. Some families preferred that their loved ones not be admitted to rehab facilities or nursing homes that they could not visit, and outpatient rehab resources were sometimes limited.
The study specifically looked at functional independence measures (FIMs) that are assessed on admission and discharge. Examples include motor skills deficits and the ability to bathe or dress oneself. Among a group of 680 patients, the team found that the longer the time span between stroke onset and rehabilitation, the lower the FIM score.
“For every additional day that they took to get into inpatient rehab, we found a 2%-5% decrease of the odds of being independent, and the effect is cumulative,” Aggarwal said. “The longer it takes for them to get into rehab, the longer it takes for them to be independent.”
The team’s findings were the subject of a poster presentation at the American Heart Association’s International Stroke Conference in March 2021.