Research Highlights:
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NEW ORLEANS
The risk of stroke among older adults diagnosed with COVID-19 was highest during the first three days of diagnosis, according to preliminary research to be presented at the American Stroke Association’s 2022 International Stroke Conference .
"Stroke after COVID-19 diagnosis is a potential complication of COVID-19 that patients and doctors should be aware of," said Quanhe Yang, Ph.D., lead author of the study and senior scientist in the Division of Diseases. Cardiac and Cerebrovascular Accidents. Prevention at the US Centers for Disease Control and Prevention (CDC) in Atlanta. “Vaccination and other preventive measures for COVID-19 are important to reduce the risk of infection and complications, including stroke.”
Previous studies have examined stroke risk among adults with COVID-19; However, the findings were inconsistent and few focused specifically on older adults, who have a higher risk of stroke.
This study examined the risk of ischemic stroke, which is a stroke due to a blocked blood vessel, among older adults diagnosed with COVID-19 by examining the health records of 37,379 Medicare beneficiaries age 65 and older.
Patients were diagnosed with COVID-19 between April 1, 2020 and February 28, 2021 and were hospitalized for stroke from January 1, 2019 to February 28, 2021. However, stroke hospitalizations cerebrovascular disease could occur before or after the diagnosis of COVID-19. Those that occurred 7 days before diagnosis or 28 days after diagnosis served as the control period.
Participants were, on average, 80 years old when they were diagnosed with COVID-19, and 57% were women. More than 75% were non-Hispanic white adults; more than 10% were non-Hispanic black adults; Less than 10% were Hispanic adults and the remainder were adults from other racial or ethnic groups.
The analysis found:
- The highest risk of stroke occurred during the first three days after COVID-19 diagnosis, 10 times higher than during the control period.
- After the first three days of COVID-19 diagnosis, the risk of stroke decreased rapidly but remained higher compared to the control period. Specifically, between days 4 and 7, the risk of stroke was 60% higher, and between days 8 and 14, the risk of stroke was 44% higher compared to the control period. The lowest stroke risk occurred after 15 to 28 days, when the risk of stroke was 9% higher than during the control period.
- A younger subset of participants, ages 65 to 74, had an increased risk of stroke after COVID-19 diagnosis, compared with those ages 85 and older, and among those without a history of stroke.
- There were no differences in stroke risk related to sex, race, and ethnicity.
“These findings may inform stroke diagnosis, treatment and care among COVID-19 patients,” Yang said. "Further studies are needed to clarify the age-dependent stroke risk associated with COVID-19."
The fifth leading cause of death in the U.S., stroke is a medical emergency that occurs when a blood vessel to the brain becomes blocked or bursts, preventing oxygen and nutrients from reaching the brain. Stroke is a leading cause of long-term disability.
Prompt treatment is critical to preventing brain damage or death, so it is important to recognize the warning signs of a stroke and take the correct action. The abbreviation FAST stands for drooping face , arm weakness , slurred speech, time to call 9-1-1.
The American Heart Association and the Centers for Disease Control and Prevention support COVID-19 vaccination , including boosters, as the best way to reduce the risk of COVID-19 infection and prevent serious illness or death , especially among people with cardiovascular disease or other medical conditions.
Limitations of the study include the potential for misclassification due to the use of real-time preliminary Medicare claims, and COVID-19 diagnosis dates may be incorrect due to limited testing availability, particularly early in the pandemic.
Subsequently, COVID-19 testing of hospitalized patients became standard, which may have contributed to the finding of an increased risk of stroke in the days immediately following COVID-19 diagnosis. Finally, the study results may not apply to adults who are not beneficiaries of fee-for-service Medicare.
Co-authors of the study are Xin Tong, MPH; Mary G. George, MD; Anping Chang, M.S.; and Robert K. Merritt II, MA The list of author disclosures is available in the abstract.
