BACKGROUND The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations. METHODS Cardiovascular procedures performed at 30 hospitals across 6 Western states in 2 large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression. RESULTS Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in 2 distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15-April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (P = .0003), older (P < .0001), Asian or Black (P = .02), or Medicare insured (P < .0001), and COVID I procedures were higher acuity (P < .0001), but not higher complexity. In COVID II, there was a trend toward more procedural deferral in regions with a higher COVID-19 burden (P = .05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases. CONCLUSIONS Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.

中文翻译：

---

COVID-19 大流行阶段的心血管程序延迟和结果：一项多中心研究。

背景 COVID-19 大流行已经扰乱了常规的心血管护理，对不同患者群体的程序延期和相关结果的影响尚不清楚。方法 分析了 2018 年 12 月至 2020 年 6 月在西方 6 个州的 30 家医院在 2 个大型非营利医疗保健系统（普罗维登斯圣约瑟夫健康中心和斯坦福医疗保健中心）进行的心血管手术的变化。使用多变量逻辑回归比较了大流行阶段的风险调整住院死亡率。结果 在 36,125 次手术（69% 经皮冠状动脉介入治疗、13% 冠状动脉旁路移植术、10% 经导管主动脉瓣置换术和 8% 外科主动脉瓣置换术）中，在 2 月 23 日的初始拐点后的 2 个不同阶段中，每周手术量发生了变化, 2020: 最初的显着延期（COVID I：3 月 15 日至 4 月 11 日），然后是恢复（COVID II：4 月 12 日起）。与 COVID 之前相比，COVID I 患者不太可能是女性 (P = .0003)、老年 (P < .0001)、亚洲人或黑人 (P = .02) 或医疗保险 (P < .0001)，和 COVID I 程序的敏锐度更高（P < .0001），但复杂性不高。在 COVID II 中，COVID-19 负担较高的地区有更多程序延期的趋势（P = .05）。与 COVID 之前相比，在 COVID 的两个阶段，风险调整后的住院死亡率没有差异。结论 在 COVID-19 大流行早期，心血管手术量显着减少，种族、性别和年龄的影响不成比例。这些发现应为我们应对未来医疗保健中断的方法提供信息。