Survey of experiences of stroke patients during and after the Artsakh War and COVID-19 Pandemic in Yerevan, Armenia

Abstract

The year of 2020 was already challenging because of worldwide COVID-19 pandemic. In Armenia, the Artsakh Second War started on September 27, 2020, resulted in a humanitarian crisis, and had a significant negative impact on provision of healthcare services. Objectives: This study aimed to understand how both war and pandemic situation affected experiences of care and well-being of stroke patients in Armenia. Methods: The study used an independent sample pre-post design in which the pre- period included the period of war in Armenia and the post- period included the post war period. Study was conducted in a single, tertiary care center in Yerevan, Armenia, enrolling adult stroke patients who received care during the defined periods. Data sources included phone surveys and medical records review for collecting information on sociodemographic and clinical characteristics, patient reported experiences, access to care and COVID-19 worry. Descriptive and inferential statistics as well as regression analysis were used to answer study questions. Results: We completed 66 interviews for each period. The mean age of patients was 64.3 (standard deviation (SD) = 10.2) years, the majority were men (5%), half were from Yerevan (51.4%), 93.8% had comorbidities, and one third (34.1%) received reperfusion therapy (RT) (p>0.05 for comparisons by time period). The overall hospital rating was high (mean = 8.6, SD=2.2), and was similar during War and post-War periods (p>0.05). Access to urgent and emergent care was not different by study period either (p>0.05) The overall rating of COVID-19 worry, and the perceived risk was low among stroke patients in both periods. In multivariable regression analyses, RT (OR = 3.52, 95% CI: 1.31 to 9.48) and diabetes (OR = 0.35, 95% CI: 0.16 to 0.94) were predictors of hospital rating. Conclusions: We found no differences in patent experiences between War and post-War periods. Considering that RT was identified as an independent predictor of positive overall hospital rating, a better capacity and infrastructure for timely access, early diagnosis and management of stroke is recommended.