COVID-19 patients have higher risk of stroke, finds study

Reviewed by Emily Henderson, B.Sc.Mar 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 prior studies. Those who had an ischemic stroke were more likely to be older, male, Black race, or have high blood pressure, Type 2 diabetes or an irregular heartbeat (atrial fibrillation) compared with other COVID-19 patients, according to late-breaking science presented today at the American Stroke Association's International Stroke Conference 2021. The meeting is being held virtually, March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

For this analysis, researchers accessed the American Heart Association's COVID-19 Cardiovascular Disease 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 more than 20,000 patients hospitalized with COVID-19 across the U.S. between January and November 2020.

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."

Saate S. Shakil, M.D., Lead Study Author, Cardiology Fellow, University of Washington in Seattle

Two hundred eighty-one people (1.4%) in the COVID-19 CVD Registry had a stroke confirmed by diagnostic imaging during hospitalization. Of these, 148 patients (52.7%) experienced ischemic stroke; 7 patients (2.5%) had transient ischemic attack (TIA); 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) than patients without stroke (average age 61);
• 44% of patients who had an ischemic stroke also had Type 2 diabetes vs. about 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 also 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; and
• 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.

"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," Shakil said. "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."

Shakil added, "It is more important than ever that we curb the spread of COVID-19 via public health interventions and widespread vaccine distribution."

In April 2020, the American Heart Association created the COVID-19 CVD Registry within weeks of the declaration of the global pandemic to rapidly collect and provide insights into patients hospitalized with the novel coronavirus. The Association's robust Get With the Guidelines registry infrastructure has allowed for rapid data collection, including over 37,000 patient records and more than 135,000 lab reports, with more than 160 registry sites enrolled (data as of 2/23/21).