Department of Internal Medicine, CHI St. Alexius Health, University of North Dakota Southwest Campus, Bismarck, ND; Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL.
Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO.
Curr Probl Cardiol. 2023 Mar;48(3):101526. doi: 10.1016/j.cpcardiol.2022.101526. Epub 2022 Nov 28.
The Coronavirus Disease-2019 (COVID-19) pandemic placed an enormous strain on the healthcare system. Data on the impact of COVID-19 on the utilization and outcomes of structural heart disease interventions in the United States are scarce. The National Inpatient Sample from 2016 to 2020 was queried to identify adult admissions for transcatheter aortic valve replacement (TAVR), left atrial appendage occlusion (LAAO), and transcatheter end-to-end repair (TEER). The primary outcome was temporal trends of procedure utilization rate per 100,000 admissions over quarters from 2016 to 2020. The secondary outcomes were adjusted rates of in-hospital mortality, major complications, and length of stay (LOS). Among 434,630 weighted admissions (TAVR: 305,550; LAAO: 89,300; TEER: 40,160), 95,010 admissions (22%) were during the COVID-19 era. There was a decline during the second quarter of 2020 followed by an increase to the pre pandemic levels (TAVR: 220 to 253, LAAO: 57 to 109, and TEER: 31 to 36 per 100,000 admissions, Ptrend<0.001). There were no differences in the mortality or major complication rates. Median LOS has decreased in TAVR (4 days-1 day) and in TEER (3 days-1 day) but remained stable in LAAO (1 day). This nationwide analysis showed that structural heart disease interventions decreased during the early waves of COVID-19 pandemic. There was a significant reduction in hospital LOS without differences in in-hospital mortality or complication rates during the pandemic. These data suggest that hospitals adapted to the unprecedent challenges during the pandemic to provide advanced cardiac care to patients.
2019 年冠状病毒病（COVID-19）大流行给医疗系统带来了巨大压力。关于 COVID-19 对美国结构性心脏病介入治疗的利用和结果的影响的数据很少。从 2016 年至 2020 年，对国家住院患者样本进行了查询，以确定经导管主动脉瓣置换术（TAVR）、左心耳封堵术（LAAO）和经导管端端修复术（TEER）的成年患者入院情况。主要结果是 2016 年至 2020 年每季度每 10 万人入院率的时间趋势。次要结果是调整后的住院死亡率、主要并发症和住院时间（LOS）率。在 434630 例加权入院患者中（TAVR：305550 例；LAAO：89300 例；TEER：40160 例），95010 例（22%）发生在 COVID-19 期间。2020 年第二季度下降后，入院率回升至大流行前水平（TAVR：220 至 253，LAAO：57 至 109，TEER：31 至 36/每 10 万人，P<0.001）。死亡率或主要并发症发生率无差异。TAVR（4 天-1 天）和 TEER（3 天-1 天）的中位 LOS 缩短，但 LAAO（1 天）保持稳定。这项全国性分析表明，结构性心脏病介入治疗在 COVID-19 大流行的早期阶段有所减少。在大流行期间，住院 LOS 显著减少，而住院死亡率或并发症发生率没有差异。这些数据表明，医院在大流行期间适应了前所未有的挑战，为患者提供了先进的心脏护理。
