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The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada
- Source :
- Canadian Journal of Cardiology. 37:1547-1554
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures. Methods Clinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures. Results We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period. Conclusions There was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization.
- Subjects :
- medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
Referral
business.industry
Proportional hazards model
medicine.medical_treatment
Hazard ratio
Percutaneous coronary intervention
Confidence interval
Emergency medicine
Pandemic
Health care
Medicine
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 0828282X
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Cardiology
- Accession number :
- edsair.doi...........7a42da6d6fc634f38e67da0e31ca1cf8