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Stroke risk higher than expected among COVID-19 patients

This news release contains updated data not listed in the abstract.

Research Highlights:

  • Analysis of data from the American Heart Association’s COVID-19 CVD Registry of more than 20,000 U.S. adults hospitalized with COVID-19 through November 2020 found that, overall, COVID-19 patients had an increased risk of stroke compared with patients who had influenza or sepsis.
  • COVID-19 patients with ischemic stroke were more likely to be older, male, Black race or have high blood pressure, Type 2 diabetes or an irregular heartbeat.

Embargoed until 10:30 a.m. CT/ 11:30 a.m. ET Friday, March 19, 2021

(NewMediaWire) – March 19, 2021 – DALLAS – New research found patients hospitalized with COVID-19 had a higher risk of stroke, compared with patients who had similar infectious conditions such as influenza and sepsis in prior studies. Those who had an ischemic stroke were more likely to be older, male, Black race, or have high blood pressure, Type 2 diabetes or an irregular heartbeat (atrial fibrillation) compared with other COVID-19 patients, according to late-breaking science presented today at the American Stroke Association’s International Stroke Conference 2021. The meeting is being held virtually, March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

For this analysis, researchers accessed the American Heart Association’s COVID-19 Cardiovascular Disease Registry to investigate stroke risk among patients hospitalized for COVID-19, their demographic characteristics, medical histories and in-hospital survival. The COVID-19 Registry data pulled for this study included more than 20,000 patients hospitalized with COVID-19 across the U.S. between January and November 2020.

“These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” said lead study author Saate S. Shakil, M.D., a cardiology fellow at the University of Washington in Seattle. “As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems.”

Two hundred eighty-one people (1.4%) in the COVID-19 CVD Registry had a stroke confirmed by diagnostic imaging during hospitalization. Of these, 148 patients (52.7%) experienced ischemic stroke; 7 patients (2.5%) had transient ischemic attack (TIA); and 127 patients (45.2%) experienced a bleeding stroke or unspecified type of stroke.

The analysis of COVID-19 patients also found:

  • Those with any type of stroke were more likely to be male (64%) and older (average age 65) than patients without stroke (average age 61);
  • 44% of patients who had an ischemic stroke also had Type 2 diabetes vs. about one-third of patients without stroke, and most of the ischemic stroke patients had high blood pressure (80%) compared to patients without stroke (58%);
  • 18% of ischemic stroke patients had atrial fibrillation, while 9% of those without stroke also had atrial fibrillation;
  • Patients who had a stroke spent an average of 22 days in the hospital, compared to 10 days of hospitalization for patients without stroke; and
  • In-hospital deaths were more than twice as high among stroke patients (37%) compared to patients without stroke (16%).

In addition, stroke risk varied by race. Black patients accounted for 27% of the patients in the COVID-19 CVD Registry pool for this analysis; however, 31% of ischemic stroke cases were among Black patients.

“We know the COVID-19 pandemic has disproportionately affected communities of color, but our research suggests Black Americans may have higher risk of ischemic stroke after contracting the virus, as well,” Shakil said. “Stroke on its own can have devastating consequences and recovering from COVID-19 is often a difficult path for those who survive. Together, they can exact a significant toll on patients who have had both conditions.”

Shakil added, “It is more important than ever that we curb the spread of COVID-19 via public health interventions and widespread vaccine distribution.”

In April 2020, the American Heart Association created the COVID-19 CVD Registry within weeks of the declaration of the global pandemic to rapidly collect and provide insights into patients hospitalized with the novel coronavirus. The Association’s robust Get With the Guidelines registry infrastructure has allowed for rapid data collection, including over 37,000 patient records and more than 135,000 lab reports, with more than 160 registry sites enrolled (data as of 2/23/21).

Co-authors are Sophia Emmons-Bell, B.A.; Christine Rutan, B.A.; Jason Walchok, B.A., N.R.P.; James A. de Lemos, M.D.; Babak Navi, M.D., M.S.; Alexander E. Merkler, M.D., M.S.; Gregory A. Roth, M.D., M.P.H.; and Mitchell S.V. Elkind, M.D., M.S., FAHA, FAAN. Disclosures are available in the abstract.

This study was funded by the American Heart Association.

Additional Resources:

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here.

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 is virtual, March 17-19, 2021. This 3-day conference features more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

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For Media Inquiries and ASA Expert Perspective:

AHA Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Bridgette McNeill: bridgette.mcneill@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org



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