CHALLENGING OUR ASSUMPTIONS AS WE PLAN FOR ACCESS TO MAJOR CARDIAC PROCEDURES DURING RECOVERY FROM THE COVID-19 PANDEMIC

BACKGROUND: At the onset of the COVID-19 pandemic in March 2020, there was an initial considerable decline in the number of major cardiac procedures (interventional cardiology, cardiac surgery, TAVI, and electrophysiology) in Ontario. Cardiac programs were concerned about managing the anticipated exponential growth of the wait list for these services throughout the pandemic and into post-pandemic recovery planning. The purpose of this project is to highlight the notable trends in wait list and procedure volumes for the major cardiac procedures from the initial ramp down of services in March 2020 to April 2021 in Ontario. METHODS AND RESULTS: To support system level planning and coordination for major cardiac procedures in Ontario, CorHealth collects prospective data from the 20 cardiac centres across the 5 regions in Ontario for each of the major cardiac procedures, otherwise known as the CorHealth Cardiac Registry. This Registry was used to identify changes in cardiac activity and the number of people waiting for each major cardiac procedures per facility and across regions. The pre-pandemic time period (January 2019-February 2020) was used as baseline data for calculation of changes during the pandemic (March 15, 2020-April 2021) for these analyses. While all cardiac procedures were dramatically reduced in the initial months of the pandemic, by April 2021, annual activity compared to pre-pandemic baseline volumes ranged from a 23% reduction (standard ablation) to a 6% increase in activity (TAVI) (Table 1). There was regional variation whereby the change in CABG volumes ranged from a 5% increase (North) to a 25% reduction in the Central and Toronto Regions. Referrals for diagnostic cardiac catheterization, cardiac surgery and electrophysiology procedures followed a similar pattern as procedure volumes. As such, the wait list for these cardiac procedures did not increase over the first 12 months of the pandemic (Figure 1). CONCLUSION: While there was a dramatic reduction in the number of cardiac procedures and surgeries during peak periods of the COVID-19 pandemic in Ontario, this was accompanied by a dramatic, and unanticipated reduction in referrals for these services. There was also evidence of regional variation within Ontario for reduction in procedure volumes compared to baseline. As the healthcare system recovers post-pandemic, a systems approach is needed to fully understand the multiple factors contributing to the reduction in referrals and regional variation during the pandemic. This information is critical for informing recovery plans while identifying opportunities to reform and improve access to care moving forward.