Stroke Risk Among Older Patients with COVID-19 Most Apparent in First 3 Days of Diagnosis

Quanhe Yang, PhD

Risk of stroke among older adults with COVID-19 was highest within the first 3 days of diagnosis, according to new data presented at International Stroke Conference 2022.

A self-controlled case series study using data from nearly 40,000 Medicare fee-for-service beneficiaries with COVID-19, results suggest the risk of acute ischemic stroke was 10 times as high during the first 3 days after diagnosis of COVID-19 as during control periods.

“Stroke following the diagnosis of COVID-19 is a possible complication of COVID-19 that patients and clinicians should be aware of,” said Quanhe Yang, PhD, lead study author and senior scientist in the Division for Heart Disease and Stroke Prevention at the US Centers for Disease Control and Prevention, in a statement. “Vaccination and other preventive measures for COVID-19 are important to reduce the risk of infection and complications including stroke.”

With the risk of stroke posing among the most significant risks to quality of life in older populations, Yang and a team of colleagues designed the current study with the intent of learning more about the risk of stroke associated with COVID-19 in older adults. To do so, they designed their study as an analysis of health at a from Medicare beneficiaries diagnosed with COVID-19 between April 1, 2020-February 28, 2021 and were hospitalized for stroke from January 1, 2019-February 28, 2021.

The primary outcomes of interest were the association between COVID-19 and acute ischemic stroke and the estimated incident rate ratios comparing incidence in risk versus control periods. For the purpose of analysis, risk periods were defined as 0-3 days from diagnosis, 4-7 days from diagnosis, 8-14 days from diagnosis, and 15-28 days from diagnosis.

The study cohort had median age at diagnosis of COVID-19 of 80.4 (IQR, 73.5-87.1) years, 56.7% were women, 75.9% were non-Hispanic White, 34% had a history of stroke, and 28.5% died before the end of the study.

Upon analysis, results indicated the risk of stroke was most apparent during the first 3 days after a COVID-19 diagnosis (IRR, 10.3 [95% CI, 9.86-10.8]). Results suggested this risk began to decline after the first 3 das but remained higher than the risk observed in the control period. Specifically, the risk between days 4-7 days was 61% greater (IRR, 1.61 [95% CI, 1.44-1.80]), the risk between days 8-14 was 44% greater (IRR, 1.44 [95% CI, 1.32-1.57]), and the risk reached its lowest 15-28 days after diagnosis (IRR, 1.09 [95% CI, 1.02-1.18]) Additionally, investigators pointed out the risk of stroke associated with COVID-19 appeared to be more prominent in patients aged 65-74 years of age compared to older patients and among those without a history of stroke.

“These findings can inform diagnosis, treatment and care of stroke among patients with COVID-19,” Yang said. “Further studies are needed to clarify the age-dependent risk of stroke associated with COVID-19.”

This study, “Covid-19 And Risk of Acute Ischemic Stroke Among Medicare Beneficiaries: Self-controlled Case Series Study,” was presented at ISC 2022.