AHA’s CVD Registry Shows Stroke Risk Is Higher Than Expected Among COVID-19 Patients

March 19, 2021—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 previous studies. Those COVID-19 patients who had an ischemic stroke were more likely to be older, male, Black race, or have high blood pressure, type 2 diabetes mellitus, or atrial fibrillation compared with other COVID-19 patients.

The findings were offered in a late-breaking science presentation at the American Stroke Association’s (ASA’s) International Stroke Conference 2021, held virtually March 17-19, 2021.

In April 2020, within weeks of the declaration of the global pandemic, the American Heart Association (AHA) created the COVID-19 Cardiovascular Disease (CVD) registry to rapidly collect and provide insights into patients hospitalized with the novel coronavirus. The AHA’s robust Get With the Guidelines registry infrastructure has allowed for rapid data collection, including > 37,000 patient records and > 135,000 lab reports, with > 160 registry sites enrolled as of February 23, 2021.

For this analysis, investigators accessed the CVD 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 > 20,000 patients hospitalized with COVID-19 across the United States between January and November 2020.

In the COVID-19 CVD registry, 281 patients (1.4%) had a stroke confirmed by diagnostic imaging during hospitalization. Of these, 148 patients (52.7%) experienced ischemic stroke, seven patients (2.5%) had transient ischemic attack, 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 years) than patients without stroke (average age, 61 years).
• 44% of patients who had an ischemic stroke also had type 2 diabetes versus approximately 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 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.
• 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.

“These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” commented Saate S. Shakil, MD, in the ASA announcement of the study. “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.” Dr. Shakil, who is lead author of the study, is a cardiology fellow at the University of Washington in Seattle, Washington.

Dr. Shakil continued, “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. 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.”

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