Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Am J Med Sci. 2022 Apr;363(4):305-310. doi: 10.1016/j.amjms.2021.09.005. Epub 2021 Sep 28.
Cardiovascular disease remains the number one cause of death globally. Patients with cardiovascular disease are at risk of poor outcomes from deferral of healthcare during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about recovery of cardiovascular hospitalizations or procedural volume following the COVID-19 surges. We sought to examine the cardiovascular diagnoses requiring healthcare utilization surrounding the first and second COVID-19 waves and characterize trends in return to pre-pandemic levels at a tertiary care center in Massachusetts.
Using electronic health records and administrative claims data, we performed a retrospective analysis of patients undergoing cardiovascular procedures and admitted to inpatient cardiology services throughout the first two COVID surges. ICD-10 codes were used to categorize admissions.
Patients who presented for care during the initial COVID-19 surge were younger, had higher comorbidity burden, and longer length-of-stay compared with pre- and post-surge. Marked declines in admissions in the first wave (to 29% of pre-surge levels) followed eventually by complete recovery were noted across all cardiac diagnoses, with smaller declines seen in the second wave. Cardiac procedural volume declined significantly during the initial surge but quickly rebounded post-surge, eventually eclipsing pre-COVID volume.
There was a gradual but initially incomplete recovery to pre-surge levels of hospitalizations and procedures during the reopening phase, which eventually rebounded to meet or exceed pre-COVID-19 levels. To the extent that this reflects deferred or foregone essential care, it may adversely affect long-term cardiovascular outcomes. These results should inform planning for cardiovascular care delivery during future pandemic surges.
心血管疾病仍然是全球头号死因。在 2019 年冠状病毒病（COVID-19）大流行期间，推迟医疗保健会使心血管疾病患者面临不良预后的风险。在 COVID-19 激增之后，关于心血管住院或手术量的恢复情况知之甚少。我们试图研究在第一波和第二波 COVID-19 期间需要医疗保健的心血管诊断，并描述马萨诸塞州一家三级保健中心恢复到大流行前水平的趋势。
我们使用电子健康记录和行政索赔数据，对在第一波和第二波 COVID 期间接受心血管手术并住院心内科治疗的患者进行了回顾性分析。ICD-10 代码用于分类入院。
与前、后两次疫情相比，在最初 COVID-19 激增期间就诊的患者年龄更小，合并症负担更高，住院时间更长。在所有心脏诊断中，第一波的入院人数明显下降（降至疫情前水平的 29%），随后最终完全恢复，第二波的降幅较小。在最初的激增期间，心脏手术量显著下降，但在疫情后迅速反弹，最终超过了 COVID 前的水平。
在重新开放阶段，住院和手术量逐渐但最初不完全恢复到疫情前水平，最终反弹至或超过 COVID-19 前水平。在某种程度上，这反映了被推迟或放弃的基本护理，可能会对长期心血管结局产生不利影响。这些结果应指导未来大流行期间心血管保健服务的规划。
