Zondag Anna G M, Haitjema Saskia, de Groot Mark C H, de Boer Annemarijn R, van Solinge Wouter W, Bots Michiel L, Vernooij Robin W M
Central Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The Netherlands
Central Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The Netherlands.
BMJ Open. 2025 Jul 16;15(7):e092374. doi: 10.1136/bmjopen-2024-092374.
During the COVID-19 pandemic, a substantial decrease was observed in hospital admissions and in-hospital procedures for patients with acute cardiovascular diseases (CVDs). The extent to which measures to prevent COVID-19 transmission, for example, lockdowns, affected the outpatient care of patients at higher cardiovascular risk remains unclear. We aimed to compare outpatient department (OPD) attendance, cardiovascular risk management (CVRM) and cardiovascular health (CVH) of patients at higher cardiovascular risk referred to an OPD of a tertiary care centre between preCOVID-19, during and postCOVID-19 periods.
DESIGN, SETTING AND PARTICIPANTS: We included all adult patients at higher cardiovascular risk referred to the cardiology, vascular medicine, diabetology, geriatrics, nephrology or multidisciplinary vascular surgery OPDs of the University Medical Centre Utrecht, the Netherlands, between March 2019 and December 2022, in a prospective cohort study.
We assessed trends in the number of first and follow-up appointments and in the completeness of extractable CVRM indicators from the electronic health record (EHR) as a proxy for CVRM guideline adherence. CVH was determined using the Life's Essential 8 metric (score 0-100, the higher score, the better). We investigated whether CVH differed between COVID-19 periods compared with the reference period (ie, 2019) and stratified by OPDs, using multivariable linear regression, adjusted for age, gender, CVD history and whether the patient had a previous appointment before the reference period.
Among 15 143 patients, we observed a 33% reduction in the weekly number of first appointments during the COVID-19 pandemic, with the largest reductions in the cardiology and nephrology OPDs, with no differences between women and men. Follow-up appointments conducted remotely, compared with before the COVID-19 pandemic, increased significantly for all OPDs. CVRM indicators were up to 11% less extractable during the first lockdown yet returned to prepandemic levels directly after the first lockdown period. The CVH score of patients visiting the nephrology, vascular medicine and geriatrics OPDs during the first lockdown was 11.23 (95% CI 2.74 to 19.72), 5.68 (95% CI 0.82 to 10.54) and 5.66 (95% CI 0.01 to 11.31) points higher, respectively, compared with the prepandemic period. In between the second and third lockdowns, the CVH score was comparable to the preCOVID reference period, yet for the cardiology OPD it was significantly higher (5.54, 95% CI 2.04 to 9.05).
During the COVID-19 pandemic, weekly numbers of first appointments to OPDs decreased, and a population with a higher CVH score (ie, better CVH) visited certain OPDs, especially during the first lockdown period. These suggest that patients with poorer CVH more often avoided or were unable to visit OPDs, which might have resulted in missed opportunities to control cardiovascular risk factors and potentially may have led to preventable disease outcomes. For future epidemics and pandemics, it seems vital to develop a strategy that includes an emphasis on seeking healthcare when needed, with specific attention to patients at higher CVD risk.
在新冠疫情期间，急性心血管疾病（CVD）患者的住院人数和住院治疗程序大幅减少。预防新冠病毒传播的措施，如封锁，对心血管疾病高风险患者门诊治疗的影响程度尚不清楚。我们旨在比较新冠疫情前、疫情期间和疫情后转诊至三级医疗中心门诊的心血管疾病高风险患者的门诊就诊情况、心血管风险管理（CVRM）和心血管健康（CVH）。
设计、设置和参与者：在一项前瞻性队列研究中，我们纳入了2019年3月至2022年12月期间转诊至荷兰乌得勒支大学医学中心心脏病学、血管医学、糖尿病学、老年医学、肾脏病学或多学科血管外科门诊的所有心血管疾病高风险成年患者。
我们评估了首次和随访预约次数的趋势，以及从电子健康记录（EHR）中提取的CVRM指标的完整性，以此作为CVRM指南依从性的替代指标。使用“生命基本8项指标”（分数0 - 100，分数越高越好）来确定CVH。我们使用多变量线性回归，对年龄、性别、CVD病史以及患者在参考期之前是否有过预约进行了调整，研究了与参考期（即2019年）相比，新冠疫情期间CVH是否存在差异，并按门诊科室进行分层。
在15143名患者中，我们观察到在新冠疫情期间首次预约的周次数减少了33%，心脏病学和肾脏病学门诊减少幅度最大，男女之间无差异。与新冠疫情前相比，所有门诊科室远程进行的随访预约显著增加。在首次封锁期间，CVRM指标的可提取性降低了11%，但在首次封锁期结束后直接恢复到疫情前水平。在首次封锁期间，就诊于肾脏病学、血管医学和老年医学门诊的患者的CVH评分分别比疫情前时期高11.23（95%CI 2.74至19.72）、5.68（95%CI 0.82至10.54）和5.66（95%CI 0.01至11.31）分。在第二次和第三次封锁之间，CVH评分与新冠疫情前参考期相当，但心脏病学门诊的评分显著更高（5.54，95%CI 2.04至9.05）。
在新冠疫情期间，门诊首次预约的周次数减少，且CVH评分较高（即CVH较好）的人群就诊于某些门诊科室，尤其是在首次封锁期间。这表明CVH较差的患者更常避免或无法就诊门诊，这可能导致控制心血管危险因素的机会错失，并可能导致可预防的疾病结局。对于未来的流行病和大流行，制定一项强调在需要时寻求医疗保健的策略似乎至关重要，尤其要特别关注心血管疾病高风险患者。
