Effects Of Decreased Access To Outpatient Care During The Covid-19 Pandemic

INTRODUCTION: In 2020, the Covid-19 pandemic caused a decrease in access to routine healthcare. The question posed was if decreased clinic hours of an outpatient congestive heart failure (CHF) clinic affected admissions or readmissions. HYPOTHESIS: The hypothesis was that decreased hours of the CHF clinic would lead to increased hospital admissions and readmissions. METHODS: A retrospective data analysis using the Epic system slicer dicer application at an independent hospital in Phoenix, Arizona. The patient population was defined as patients seen with a heart failure diagnosis at the independent hospital.The time frames used for comparison include the years of 2019 and 2020 that were further broken down. January-March the CHF clinic operated 2 days a week in 2020, May 2020 the CHF clinic was closed and July- September 2020 the CHF clinic returned to 5 days a week. The proportion of the total patient population with at least one heart failure admission for each time period was calculated and the 2019 vs. 2020 proportions were compared using a two sample test of proportions and correspond confidence intervals.The percentage of patients readmitted for heart failure within 30 days out of the number patients who were admitted at least once were also compared for 2019 and 2020 during the time frames specified. Confidence intervals and p-values were calculated using a two sample test of proportions to determine if there was a statistically significant difference between the proportion of patients readmitted for heart failure in the years 2019 versus 2020 during the time frame specified. RESULTS: For the time periods considered, the proportions of patients admitted at least once as well as the proportion of patients readmitted were higher in 2019 compared to 2020.When the entire years of 2019 and 2020 were compared there was a 2.5% higher admission rate in 2019 compared to 2020 (p=0.003, 95% CI=[0.9%, 4.2%]) and 3.2% higher readmission rate (p=0.04, 95% CI=[0.1%, 6.3%]). January- March was compared in 2019 vs. 2020, there was a 2.5% higher admission rate in 2019 (p=0.001, 95% CI=[1.0%, 4.0%]). There was no significant statistical difference for readmissions. May of 2019 had a 1.7% higher admission rate than May of 2020 (p<0.001, 95% CI=[0.7%, 2.6%]). We observed 5.0% higher readmissions in May 2019 compared to May 2020 but was not statistically significant (p=0.31, 95% CI=[-4.5%, 14.4%]).July-September of 2019 had a 2.6% higher admission rate compared to 2020 (p<0.001, 95% CI=[1.3%, 3.9%]). The percentage of readmissions was estimated to be 3.2% higher in July- September 2019 vs 2020, but was not statistically significant. CONCLUSION: In conclusion there was a decrease in admissions in 2020 vs 2019 despite decreased access. Factors to consider that may affect the outcome are travel and restaurant restrictions, as well as hesitancy to seek care during the 2020 pandemic. This may have led to care at different hospitals and more adherence to dietary restrictions at home. Improvement in guideline directed medical therapy and individual provider outreach also cannot be excluded.