key: cord-309227-kgrfnkns
authors: Coote, Skye; Cadilhac, Dominique A.; O’Brien, Elizabeth; Middleton, Sandy
title: Letter to the Editor regarding: Critical considerations for stroke management during COVID-19 pandemic by Inglis et al., Heart Lung Circ. 2020;29(9): 1263–1267.
date: 2020-10-09
journal: Heart Lung Circ
DOI: 10.1016/j.hlc.2020.09.925
sha: 
doc_id: 309227
cord_uid: kgrfnkns

nan

To the Editor, We thank Inglis and colleagues for the recent CSANZ COVID-19 Cardiovascular Nursing Care Consensus Statement [1] and for highlighting important issues in cardiovascular and cerebrovascular disease nursing management during the COVID-19 pandemic. While many of the identified issues apply to patients with cardiac disease or stroke, several fundamental differences affecting patients with stroke require distinction.

Globally, stroke is a leading cause of disability and death. Any delays in presentation or treatment contribute to long-term disability. Transient ischaemic attacks (TIA) can often precede a major stroke, and rapid identification of cause and initiation of targeted secondary prevention is a critical step in risk-reduction [2] . Stroke/TIA presentations, particularly among those with milder symptoms, have fallen substantially across the world during the pandemic, potentially resulting in more severe stroke events or disability from delayed treatment [2] [3] [4] .

Diagnosis of stroke and treatment involves multiple hospital departments and should be streamlined and guided by an interdisciplinary team. COVID-19 has negatively impacted hospital workflows and has led to redeployment of staff resources, including nurses who work in Stroke Units [2] . Without the care of specialist multidisciplinary teams in a dedicated stroke unit, patients face higher rates of complications, disability and mortality [2, 4, 5] .

Physically segregated emergency department workspaces impede workflows and can delay referrals to the stroke team, and lengthy brain scanner decontamination times can delay diagnosis and treatment decisions [2] [3] [4] . With a causal relationship established between treatment delays and disability/mortality rates, these delays can have disastrous consequences [6] .

CSANZ COVID-19 cardiovascular nursing care consensus statement: Executive summary

COVID-19 and stroke -A global World Stroke Organization perspective

Delayed presentation of acute ischemic strokes during the COVID-19 crisis

Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions

SSA statement of stroke care during the COVID-19 Stroke Society of Australasia

Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials

This de-valuing of hospital response times and services has resulted in the Stroke Society of Australasia's plea to hospital executives to protect the integrity of stroke services [5] .It remains essential that the Face, Arms, Speech, Time (FAST) message detailing the signs of stroke is well publicised, and people with suspected stroke do not hesitate to call an ambulance. Moreover, hospital workflows and processes, while needing to be flexible in these unprecedented times, should not be altered to such a degree that patients presenting with stroke are disadvantaged.J o u r n a l P r e -p r o o f