Clinical characteristics and outcomes of acute ischemic stroke in Hiroshima city during the COVID-19 era from HARP study

Background and Purpose: To clarify the clinical characteristics and outcomes for acute ischemic stroke patients during the COVID-19 era using a multi-center stroke registry in Hiroshima city. Methods: We analyzed 4111 cases of acute ischemic stroke from July 2020 to April 2023. We defined the period from July 2020 to July 2022 as the epidemic phase and the period from August 2022 onward, when the numbers of COVID-19 patients surged, as the endemic phase. Results: Compared to the epidemic phase group (n=2985), the endemic phase group (n=1126) had a significantly higher incidence of atrial fibrillation and chronic heart failure (p=0.003 and p=0.001, respectively). There was no difference in the rate of reperfusion therapy between the two groups. Although the time from discovery to hospital arrival was significantly longer in the endemic phase group (p=0.024), there was no difference in the time from hospital arrival to treatment initiation or in outcomes at 3 months. Conclusion: During the endemic phase, when the number of COVID-19 patients increased, there was an increase in ischemic strokes with atrial fibrillation and heart failure. In cases undergoing reperfusion therapy, the time from discovery to hospital arrival was significantly prolonged in the endemic phase group.