Purdue University School of Nursing, West Lafayette, IN, USA.
Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107140. doi: 10.1016/j.jstrokecerebrovasdis.2023.107140. Epub 2023 Apr 14.
To study factors associated with systolic blood pressure(SBP) control for patients post-discharge from an ischemic stroke or transient ischemic attack(TIA) during the early months of the COVID-19 pandemic compared to pre-pandemic periods within the Veterans Health Administration(VHA).
We analyzed retrospective data from patients discharged from Emergency Departments or inpatient admissions after an ischemic stroke or TIA. Cohorts consisted of 2,816 patients during March-September 2020 and 11,900 during the same months in 2017-2019. Outcomes included primary care or neurology clinic visits, recorded blood pressure readings and average blood pressure control in the 90-days post-discharge. Random effect logit models were used to compare clinical characteristics of the cohorts and relationships between patient characteristics and outcomes.
The majority (73%) of patients with recorded readings during the COVID-19 period had a mean post-discharge SBP within goal (<140 mmHg); this was slightly lower than the pre-COVID-19 period (78%; p=0.001). Only 38% of the COVID-19 cohort had a recorded SBP in the 90-days post-discharge compared with 83% of patients during the pre-pandemic period (p=0.001). During the pandemic period, 29% did not have follow-up primary care or neurologist visits, and 33% had a phone or video visit without a recorded SBP reading.
Patients with an acute cerebrovascular event during the initial COVID-19 period were less likely to have outpatient visits or blood pressure measurements than during the pre-pandemic period; patients with uncontrolled SBP should be targeted for follow-up hypertension management.
与退伍军人事务部（Veterans Health Administration，VHA）在 COVID-19 大流行前相比，研究 COVID-19 大流行早期缺血性卒中和短暂性脑缺血发作（TIA）出院后患者的收缩压（SBP）控制相关因素。
我们分析了从急诊或缺血性卒中和 TIA 住院患者出院后到 90 天的门诊就诊、记录血压读数和平均血压控制情况的回顾性数据。队列包括 2020 年 3 月至 9 月期间的 2816 例患者和 2017 年至 2019 年同期的 11900 例患者。结果包括初级保健或神经病学门诊就诊、记录的血压读数和出院后 90 天内的平均血压控制情况。使用随机效应逻辑模型比较队列的临床特征以及患者特征与结果之间的关系。
在 COVID-19 期间有记录读数的患者中，大多数（73%）的出院后 SBP 处于目标范围内（<140mmHg）；这略低于 COVID-19 前时期（78%；p=0.001）。与 COVID-19 队列相比，在 COVID-19 期间，只有 38%的患者在出院后 90 天内有记录的 SBP，而在 COVID-19 前时期，有 83%的患者有记录的 SBP（p=0.001）。在大流行期间，29%的患者没有进行门诊随访或神经病学随访，33%的患者进行了电话或视频访问，但没有记录 SBP 读数。
与 COVID-19 前时期相比，急性脑血管事件患者在 COVID-19 初期进行门诊就诊或血压测量的可能性较低；应针对未控制 SBP 的患者进行高血压管理的随访。
