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Cardiovascular procedural deferral and outcomes over COVID-19 pandemic phases: A multi-center study.
Cardiovascular procedural deferral and outcomes over COVID-19 pandemic phases: A multi-center study.
- Source :
- American Heart Journal; Nov2021, Vol. 241, p14-25, 12p
- Publication Year :
- 2021
-
Abstract
- <bold>Background: </bold>The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00028703
- Volume :
- 241
- Database :
- Supplemental Index
- Journal :
- American Heart Journal
- Publication Type :
- Academic Journal
- Accession number :
- 152710553
- Full Text :
- https://doi.org/10.1016/j.ahj.2021.06.011