Risk of In-Hospital Stroke Higher Among Those With COVID-19

A study presented at the American Stroke Association’s virtual International Stroke Conference 2021 showed individuals hospitalized with COVID-19 had a higher risk of stroke compared to those who were hospitalized due to influenza or sepsis. Data used in the study are from the American Heart Association’s COVID-19 Cardiovascular Disease Registry, which includes more than 20,000 cases of individuals hospitalized due to COVID-19 in US between January and November 2020. 

Individuals who had a stroke while hospitalized with COVID-19 spent a mean 12 days longer in the hospital than those with COVID-19 only (22 vs 10 days). In-hospital deaths were more than twofold higher for those with COVID-19 and stroke (37%) compared with those who had COVID-19 only (16%). Individuals with who had a stroke while hospitalized with COVID-19 were disproportionately Black (27%) and Black people accounted for a disproportionately high proportion of those with ischemic stroke (31%).

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

Diagnostic imaging confirmed stroke in 1.4% of people included in the study, and of the 281 ischemic strokes diagnosed, 52.7% were ischemic, 2.5% were transient ischemic attacks; and 45.2% were hemorrhagic or unspecified. Among people with ischemic strokes, approximately 44% had type 2 diabetes compared with 33% in individuals with COVID-19 who did not have a stroke. The majority of individuals who had a stroke also had high blood pressure compared with those who did not have a stroke (88% vs 58%). Atrial fibrillation was present in 18% of persons with COVID-19 and stroke vs 9% in those with COVID-19 only.