AHA Registry Provides Comprehensive Review of Ischemic Stroke in COVID-19 Patients

Saate Shakil, MD

An analysis of the American Heart Association’s COVID-19 Cardiovascular Disease Registry is providing what could be the most comprehensive review of ischemic stroke in COVID-19 patients since the pandemic has begun.

Presented at the International Stroke Conference (ISC) 2021, results of the analysis offer insight into the increased risk of in-hospital death, the prevalence of specific risk factors such as diabetes and atrial fibrillation, and racial disparities in stroke incidence seen among hospitalized COVID-19 patients from across the US.

“These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” said lead investigator Saate S. Shakil, MD, a cardiology fellow at the University of Washington in Seattle, in a statement. “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.”

Created by the AHA in April 2020, the COVID-19 Cardiovascular Disease Registry was formed with the goal of collecting and providing clinicians and researchers with insight into data related to patients hospitalized with COVID-19. With data obtained from more than 20,000 patients hospitalized at 160 sites from March-November 2020, the registry provided sufficient data for investigators to evaluate stroke risk, treatments administered, and in-hospital mortality of these patients and assess them for potential associations based on demographic characteristics and medical histories.

Among 21,073 patients assessed in the analysis, investigators identified 160 (0.75%) patients who experienced an ischemic stroke and 20,784 that experienced no stroke. Compared to those who did not experience a stroke event, those with ischemic stroke had a greater average age (65.2 vs 61.1 years) and were more likely to be male (63.1% vs 53.9%). Additionally, hypertension, atrial fibrillation, diabetes, and cerebrovascular disease were more prevalent among COVID-19 patients who suffered an ischemic stroke.

During her presentation, Shakil took time to note the prevalence of hypertension was increased throughout the study cohort—with a prevalence rate of 80% among those with ischemic stroke and 58% of patients with no stroke.

When assessing outcomes, results indicated patients with COVID-19 and ischemic stroke were twice as likely to be admitted to the ICU, require mechanical ventilation, and need new renal replacement therapy when compared to those without stroke. Results also pointed to increased length of hospital stays (22 vs 10 days) and risk of in-hospital mortality (37% vs 16%) when comparing those with ischemic stroke and those without a stroke.

Further analysis of baseline demographics between groups indicated racial disparities in stroke risk among COVID-19 patients. Despite accounting for just 27% of patients in the 21,073-person study cohort, 31% of ischemic strokes occurred in non-Hispanic Black patients. Overall, risk of ischemic stroke was lowest among Hispanic patients (0.52%) followed by non-Hispanic White (0.75%) patients, and the highest level of risk was seen among non-Hispanic Black (0.91%) patients. Shakil noted American Indian/Alaska Native, Asian, Native Hawaiian, and Pacific Islander were categorized into a category as other races and their analysis indicated an increased risk of stroke among these 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.”

This study, “Stroke Among Patients Hospitalized With COVID-19 In The United States: Results From The AHA COVID-19 Cardiovascular Disease Registry,” was presented at ISC 21.