Elsevier

American Heart Journal

Volume 241, November 2021, Pages 14-25
American Heart Journal

Clinical Investigations
Cardiovascular procedural deferral and outcomes over COVID-19 pandemic phases: A multi-center study

https://doi.org/10.1016/j.ahj.2021.06.011Get rights and content
Under a Creative Commons license
open access

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.

Abbreviations

CABG
coronary artery bypass graft
CC
complication or comorbidity
CPT
Current Procedural Terminology
ICD-10
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision
LOS
length of stay
MCC
major complication or comorbidity
MS-DRG
Medicare Severity-Diagnosis Related Groups
NSTE-ACS
Non–ST elevation acute coronary syndrome
PCI
percutaneous coronary intervention
SAVR
surgical aortic valve replacement
SIHD
stable ischemic heart disease
STEMI
ST-elevation myocardial infarction
TAVR
transcatheter aortic valve replacement

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