In Ontario on March 16, 2020, a directive was issued to all acute care hospitals to halt nonessential procedures in anticipation of a potential surge in COVID-19 patients. This included scheduled outpatient cardiac surgical and interventional procedures that required the use of intensive care units, ventilators, and skilled critical care personnel, given that these procedures would draw from the same pool of resources required for critically ill COVID-19 patients. We adapted the COVID-19 Resource Estimator (CORE) decision analytic model by adding a cardiac component to determine the impact of various policy decisions on the incremental waitlist growth and estimated waitlist mortality for 3 key groups of cardiovascular disease patients: coronary artery disease, valvular heart disease, and arrhythmias. We provided predictions based on COVID-19 epidemiology available in real-time, in 3 phases. First, in the initial crisis phase, in a worst case scenario, we showed that the potential number of waitlist related cardiac deaths would be orders of magnitude less than those who would die of COVID-19 if critical cardiac care resources were diverted to the care of COVID-19 patients. Second, with better local epidemiology data, we predicted that across 5 regions of Ontario, there may be insufficient resources to resume all elective outpatient cardiac procedures. Finally in the recovery phase, we showed that the estimated incremental growth in waitlist for all cardiac procedures is likely substantial. These outputs informed timely data-driven decisions during the COVID-19 pandemic regarding the provision of cardiovascular care.

2020年3月16日在安大略省，向所有急诊医院发出了一项指令，以终止不必要的程序，以防止COVID-19患者可能出现激增。这包括需要使用重症监护病房，呼吸机和熟练的重症监护人员的定期门诊心脏外科手术和介入程序，因为这些程序将使用重症COVID-19患者所需的资源。我们通过添加一个心脏组件来确定各种政策决策对心血管疾病患者的三个关键组（冠状动脉疾病，心脏瓣膜病）的各种候补决定的影响，以适应各种COVID-19资源估算器（CORE）决策分析模型的变化：心脏病和心律不齐。我们提供了基于COVID-19流行病学的三个阶段的实时预测。首先，在最初的危机阶段，在最坏的情况下，我们表明，如果将关键的心脏护理资源转移到护理中，与等待者名单相关的心脏病死亡人数将比死于COVID-19的人数少几个数量级。 COVID-19患者。其次，利用更好的当地流行病学数据，我们预测安大略省的5个地区可能没有足够的资源来恢复所有选择性门诊心脏手术。最终，在恢复阶段，我们表明所有心脏手术的候补名单中估计的增量增长可能是巨大的。这些输出为在COVID-19大流行期间有关提供心血管保健的及时数据驱动型决策提供了依据。