Consequences of a Significant Decrease in Cardiac Interventions During the Pandemic: Canadian Study

Newswise – Philadelphia, September 29, 2021 – An analysis of health care data in Ontario, Canada, found a significant drop in referrals and procedures performed for common heart procedures after the start of the COVID-19 pandemic. Patients waiting for coronary bypass surgery or a stent were at a higher risk of dying while waiting for their surgery than before the pandemic, although wait times were not longer. The to study emphasizes the importance of prompt symptom recognition and treatment in patients at high risk for cardiovascular disease, researchers in the Canadian Journal of Cardiology, published by Elsevier.

“During the first wave of the COVID-19 pandemic, we kept hearing stories from patients and other doctors that there were delays in care for patients with heart disease,” explained principal investigator Harindra C. Wijeysundera, MD, PhD, Institute of Health Policy, Management and Evaluation, University of Toronto; ICES; and Division of Cardiology, Department of Medicine, Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada. “We decided to review these claims using the Ontario database that tracks wait lists and wait times for people with heart disease who need help. ‘an intervention or surgery.

Waiting lists for procedures are not unusual in publicly funded health systems. Canadian provinces regularly monitor and publish wait times for cardiac care. Researchers were able to link multiple population-based administrative data sources and clinical registries hosted at ICES, Canada’s largest health services research institute. The study involved patients over 18 who were referred for four common cardiac procedures: percutaneous coronary intervention (PCI); isolated coronary bypass surgery (PAC); valve surgery (aortic, mitral or tricuspid); or catheter aortic valve implantation (TAVI) from January 1, 2014 to September 30, 2020. For the purposes of the study, the onset of the COVID-19 pandemic was defined as March 15, 2020, when health authorities in the Ontario issued a directive that canceled elective surgical procedures. Outcomes were defined as death while waiting for surgery and hospitalization while waiting for surgery.

A total of 584,341 patients were identified, of which 37,718 were referred during the pandemic. As expected, a drop in referrals was observed early in the pandemic, although these numbers have steadily increased throughout the pandemic period. Likewise, the researchers observed an initial drop in the number of procedures performed. People waiting for coronary artery bypass surgery or a stent were at a higher risk of dying while waiting for their surgery than before the pandemic. Surprisingly, death rates have increased even though wait times have not increased during the pandemic, suggesting that patients may have been slow to present to their doctors with symptoms.

“We found that the increase in waitlist mortality was consistent in patients with stable coronary artery disease, acute coronary syndrome, or emergency referral,” said Dr. Wijeysundera . “Coupled with reduced referrals, this raises concerns about a care gap due to delays in diagnosis and referral on the waiting list. “

Researchers suggest a number of potential explanations for the lower benchmarks during the pandemic, ranging from patient-related factors such as fear of contracting COVID-19 in hospital or concerns about absences from work, to systemic factors including delays in tests and hospital beds and pressure on staff. .

In a accompanying editorial, Michelle M. Graham, MD, and Christopher S. Simpson, MD, Division of Cardiology and Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute (MMG), and Division of Cardiology and Department of Medicine, Queen’s University ( CS), Edmonton and Kingston, Canada, emphasized that moving outpatients to a waiting list system should not be dependent on the patient self-reporting a change in symptoms. In contrast, hospitalized patients are continuously monitored and assessed, allowing deterioration to be detected more quickly.

“When the patients are at home,” they said, “no one is looking at them. “The missing patient” must now be recognized by decision-makers, policymakers and health system funders. “

This research suggests that any reduction in cardiac procedural capacity to accommodate critically ill COVID-19 patients must be weighed against the actual risk of waitlist mortality observed in this study. “We believe this is very relevant for the recovery phase of the pandemic,” commented Dr Wijeysundera. “Efforts should not only be aimed at increasing the capacity to treat patients on the waiting lists, but also efforts should be made to identify upstream barriers that have prevented patients from getting on the waiting list. ‘waiting. “

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