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The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada
BACKGROUND: The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortalit...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Canadian Cardiovascular Society. Published by Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481095/ https://www.ncbi.nlm.nih.gov/pubmed/34600793 http://dx.doi.org/10.1016/j.cjca.2021.05.008 |
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author | Tam, Derrick Y. Qiu, Feng Manoragavan, Ragavie Fremes, Stephen E. Hassan, Ansar Ko, Dennis T. Lauck, Sandra B. Naimark, David Ouzounian, Maral Sander, Beate Sun, Louise Wijeysundera, Harindra C. |
author_facet | Tam, Derrick Y. Qiu, Feng Manoragavan, Ragavie Fremes, Stephen E. Hassan, Ansar Ko, Dennis T. Lauck, Sandra B. Naimark, David Ouzounian, Maral Sander, Beate Sun, Louise Wijeysundera, Harindra C. |
author_sort | Tam, Derrick Y. |
collection | PubMed |
description | BACKGROUND: The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures. METHODS: Clinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures. RESULTS: We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period. CONCLUSIONS: There was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization. |
format | Online Article Text |
id | pubmed-8481095 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Canadian Cardiovascular Society. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84810952021-09-30 The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada Tam, Derrick Y. Qiu, Feng Manoragavan, Ragavie Fremes, Stephen E. Hassan, Ansar Ko, Dennis T. Lauck, Sandra B. Naimark, David Ouzounian, Maral Sander, Beate Sun, Louise Wijeysundera, Harindra C. Can J Cardiol Clinical Research BACKGROUND: The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures. METHODS: Clinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures. RESULTS: We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period. CONCLUSIONS: There was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization. Canadian Cardiovascular Society. Published by Elsevier Inc. 2021-10 2021-09-30 /pmc/articles/PMC8481095/ /pubmed/34600793 http://dx.doi.org/10.1016/j.cjca.2021.05.008 Text en © 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Clinical Research Tam, Derrick Y. Qiu, Feng Manoragavan, Ragavie Fremes, Stephen E. Hassan, Ansar Ko, Dennis T. Lauck, Sandra B. Naimark, David Ouzounian, Maral Sander, Beate Sun, Louise Wijeysundera, Harindra C. The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada |
title | The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada |
title_full | The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada |
title_fullStr | The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada |
title_full_unstemmed | The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada |
title_short | The Impact of the COVID-19 Pandemic on Cardiac Procedure Wait List Mortality in Ontario, Canada |
title_sort | impact of the covid-19 pandemic on cardiac procedure wait list mortality in ontario, canada |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481095/ https://www.ncbi.nlm.nih.gov/pubmed/34600793 http://dx.doi.org/10.1016/j.cjca.2021.05.008 |
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