Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA; Department of Medicine, Stanford University School of Medicine, and Stanford Cardiovascular Institute, Stanford, CA.
Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR.
Am Heart J. 2021 Nov;241:14-25. doi: 10.1016/j.ahj.2021.06.011. Epub 2021 Jun 26.
The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations.
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.
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.
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.
COVID-19 大流行扰乱了常规心血管护理，尚不清楚在不同患者人群中对程序延迟及其相关结果的影响。
分析了 2018 年 12 月至 2020 年 6 月在 6 个西部州的 30 家医院进行的心血管程序，这些医院来自 2 个大型非营利性医疗保健系统（普罗维登斯圣约瑟夫健康和斯坦福健康）。使用多元逻辑回归比较大流行各阶段的风险调整住院死亡率。
在 36125 例手术中（69%为经皮冠状动脉介入治疗，13%为冠状动脉旁路移植术，10%为经导管主动脉瓣置换术，8%为外科主动脉瓣置换术），在 2020 年 2 月 23 日初始拐点之后，每周手术量有两个明显不同的阶段：最初的大量延迟（COVID I：3 月 15 日至 4 月 11 日），然后是恢复期（COVID II：4 月 12 日及以后）。与 COVID 前相比，COVID I 患者中女性（P=0.0003）、年龄较大（P<0.0001）、亚洲人或黑人（P=0.02）或医疗保险的比例较低（P<0.0001），COVID I 手术的疾病严重程度更高（P<0.0001），但手术复杂性没有增加。在 COVID II 中，在 COVID-19 负担较重的地区，有更多的程序延迟的趋势（P=0.05）。与 COVID 前相比，在 COVID 两个阶段，风险调整后的住院死亡率没有差异。
COVID-19 大流行早期，心血管手术量大幅减少，不同种族、性别和年龄的影响程度不同。这些发现应指导我们应对未来的医疗保健中断。
