STROKE care was significantly disrupted during the COVID-19 pandemic, according to a scoping review that analysed 107 studies and highlighted widespread changes in healthcare utilisation, treatment delivery, and patient outcomes.
The review examined evidence published between December 2019 and September 2024 and aimed to assess how the pandemic affected patients with stroke across the care continuum.
Researchers screened 1,405 studies and included 107 that met the eligibility criteria.
Analysis identified seven major subthemes affecting stroke care. These themes were grouped into patient conduct, stroke characteristics, and healthcare delivery.
The review found that many patients delayed seeking care because of concerns about contracting COVID-19 in hospital settings and perceptions that healthcare services were overwhelmed.
Delays were particularly evident among individuals with milder symptoms, often resulting in presentation outside critical treatment windows.
The rapid adoption of telemedicine helped maintain some continuity of care, particularly among younger patients, although lower utilisation among older adults highlighted persistent inequalities in access to remote services.
Several studies reported reductions in stroke admissions during the pandemic. One study found a 31% decrease in monthly ischaemic stroke admissions, while another reported a 44% decrease.
At the same time, patients who presented to hospital frequently had more severe strokes than those seen before the pandemic.
Evidence suggested that delayed presentation, social isolation, and reluctance to seek emergency care contributed to more severe disease at admission.
The review also found poorer recovery outcomes among some patients.
In one study, disability at discharge was significantly higher during the pandemic, with a median modified Rankin Scale score of 4 versus 2 before the pandemic. These differences persisted at 3 months after stroke.
Healthcare systems faced substantial strain during the pandemic, leading to resource reallocation, workforce shortages, and changes in stroke pathways.
Several studies linked these disruptions to poorer outcomes and increased mortality.
One analysis reported higher mortality at discharge among patients treated during the pandemic compared with pre-pandemic cohorts, with mortality rates of 7.7% versus 2.5%, respectively.
The researchers concluded that future emergency preparedness efforts should prioritise adaptable stroke care systems, equitable telemedicine access, patient education, and strategies to minimise treatment delays during public health crises.
Reference
Ménard A et al. Navigating stroke care during the COVID-19 pandemic: a scoping review. BMC Health Serv Res. 2026;DOI:10.1186/s12913-026-15676-8.
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