University of Melbourne-based researcher and entrepreneur, Professor Roland Bammer, and his clinical colleagues, Dr Shalini Amukotuwa and Dr Julian Maingard from Monash Health have released sobering findings on the extent to which patients with time-sensitive medical conditions, such as strokes, may have missed out on treatment by avoiding hospitals throughout the COVID-19 pandemic.
Their latest study, Where have our patients gone? The impact of COVID-19 on stroke imaging and intervention at an Australian stroke centre, published this month in Journal of Medical Imaging and Radiation Oncology, reveals that it is not just those Australians who’ve contracted the virus at risk of developing long-term health problems because of the pandemic.
It was shown that in March and April 2020, there was a marked decrease in the number of acute stroke patients presenting to hospitals and associated CT scans.
“The study was performed at Monash Health, a network of four hospitals with a catchment area of over two million people,” explains Roland, “but similar patterns were observed all across Australia and globally”.
The researchers concluded that the main driving force behind the decline was patients avoiding going to a hospital or accessing other medical care because of social distancing rules, the lockdown and fears of contracting COVID-19.
“My clinical colleagues concluded, that it appears that people were just too scared to go to hospital,” says Roland. “If they had their strokes at home, we would expect that the severity of strokes would be higher, or some may even be fatal because they didn’t get treated in time.
“However, we didn’t have the resources to follow this up, so this conclusion is purely speculative,” he acknowledges.
Roland says that in Italy, France, Spain and the Northeast of the USA, which were hit hard by the pandemic, the health systems were overwhelmed during the first wave of COVID-19. It is unlikely that this contributed to the decline in the number of stroke presentations in Australia, however, because we didn’t have a surge in COVID-19 patients. There was, in fact, a decrease in the number of emergency department presentations during the same time period. Our health system, including acute stroke services, was also better prepared than in Europe and the United States, and coped well.
Worryingly, Roland quotes studies from the US and Australia that the number of patients seeking care for other time-sensitive conditions like heart attacks and cancer decreased.
Roland also wants to echo the opinion of his clinical colleagues: “Although a lot of attention is focussed on COVID, people continue to experience other medical emergencies such as stroke and heart attacks. Hospitals in Australia are still providing excellent care for these patients. “It’s really important, therefore, that the community understands that the lockdown doesn’t prevent people with medical emergencies from accessing care. Hospitals sequester COVID patients from the rest of the patients by having separate Emergency Department and Radiology sections and different wards or even wings in the hospital, to avoid cross-infections.”
How RapidAI is helping stroke outcomes
Separate from his research work, Roland and co-founder, Greg Albers, launched RapidAI in Silicon Valley in 2012.
“The business initially attracted philanthropic support and then received funding from Don Valentine, the founding father of venture capital and founder of Sequoia Capital,” says Roland.
RapidAI has grown to become the world leader in advanced imaging for stroke. The company’s data-driven technology allows clinicians to make faster, more accurate diagnostic and treatment decisions for stroke and aneurysm patients. The Rapid platform, which uses Artificial Intelligence and Deep Learning, is currently installed in over 1,500 hospitals throughout more than 50 countries.
Roland explains: “Until around 2015 if you had a stroke and waited longer than four and a half hours, the doctor looked at you and said, ‘you’ve had a stroke, but I can’t do much.’
“This was because the only accepted therapy was a ‘Clot Busting’ drug, and its use was limited to the first four and a half hours after a stroke. So, only five per cent of all stroke patients could benefit from a Clot Buster and in only between 10 and 20 per cent of that small number of patients could you reopen the blood vessels. So, you ended up with a lot of patients with severe impairments or even dying.”
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“Around 2015, a new technique that involves removing the clot using special minimally invasive intravascular devices were finally validated in a number of high-profile clinical trials (including one from Australia). “Fishing” out the clot from within the blocked artery have an 80 to 90 per cent success rate in restoring blood flow. The procedure has resulted in positive outcomes even in patients who are treated up to 24 hours from stroke onset. These patients can often leave the hospital the next day and experience minimal long-term effects.
“This has revolutionised stroke therapy,” says Roland. “And the big thing for Australia is that we are such a vast country, although we have a highly concentrated population in metropolitan areas. Only hospitals in central metropolitan areas offer this ‘clot retrieval treatment’ for stroke. If you live somewhere outside the big cities, it still takes time to travel to the hospital.”
So, what is RapidAI’s role in the treatment of strokes?
“In many stroke patients, there is still a part of the brain that doesn’t get enough blood but is not yet irreversibly damaged,” explains Roland. “The damage increases over the time, but the rate at which this happens is different in each patient. Even after 24 hours, some patients have brain tissue that’s still alive and can be saved. This does not mean, however, that doctors can twiddle their thumbs. Getting treatment fast is still paramount. If doctors can restore blood flow to that region, it prevents it from dying and can limit the patient’s disability.
“Our software allows doctors treating stroke patients to use CT and MRI scans to identify the dead tissue and estimate how much brain tissue can still be saved. This, in turn, helps identify those patients who can benefit from treatment that restores blood flow and those for whom intervention may create harm. Our software is also helping to coordinate care between smaller hospitals (where patients often present first) and larger hospitals (where the blot clot is removed).
“We are also using AI to help detect brain bleeds and aneurysms,” says Roland. When patients come to a hospital to get a CT or MRI scan, sometimes the radiologist doesn’t have time right away, and AI makes the screening of patients much faster, drawing the doctors’ attention if a scan needs to be looked at right away. It’s like another pair of eyes that never sleeps or gets tired. For aneurysms we also help with pre-surgical planning and have just acquired another company to help servicing this important segment.”
Australian hospitals have used RapidAI research for many years, but the company established an Australian subsidiary in 2020.
The Australian business has achieved some impressive milestones, with the platform already being used by 45 hospitals and Teleradiology services across NSW, Victoria, and Queensland and is rapidly expanding.
RapidAI is also being utilised state-wide in NSW’s TeleHealth initiative, to optimize its ‘hub and spoke’ network of 25 hospitals, and use Rapid’s Mobile App to optimise workflow, communication, and expedite patient treatment.
“Our goal is to get a broader adoption in Australia and give Australian hospitals the same opportunities as hospitals in the United States to optimize the journey of each stroke patient through coordinating care across hospitals through our Mobile App,” says Roland.
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