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

Yong CM, Spinelli KJ, Chiu ST, Jones B, Penny B, Gummidipundi S, Beach S, Perino A, Turakhia M, Heidenreich P, Gluckman TJ. Cardiovascular procedural deferral and outcomes over COVID-19 pandemic phases: A multi-center study. American heart journal. 2021 Nov 1; 241:14-25.

Related HSR&D Project(s)

• CDA 15-072 – Optimizing Access, Appropriateness, and Quality of Minimally Invasive Procedures for Veterans

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Abstract:

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.