We had the pleasure of reading the article ‘Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis’ by Ferrone et al. with great interest.1 In particular, the reduced odds of home discharge for patients with stroke who have COVID-19 presents an interesting insight into the management challenges while caring for these patients.

However, we would like to highlight some concerns about the methodology of the study. Heterogeneity is defined as observed intervention effects being more different from each other than one would expect due to random error (chance) alone.2 For the outcomes of in-hospital mortality and discharge modified Rankin Scale (mRS) score 0–2 the heterogeneity (I2) was 86.7% (P<0.001) and 93.0% (P<0.001), respectively, which is regarded as considerable (75– 100%). …