Variations of cardiovascular procedures (diagnostic and therapeutic) in France during COVID-19 epidemic (2020–21): An observational nationwide study

INTRODUCTION: Organization and use of healthcare systems were impacted by the occurrence of COVID-19 pandemic and lockdown (first one: March 17/May 10, 2020). Patients with acute or chronic diseases were faced with disruptions hospital stays and scheduled surgery. OBJECTIVE: Temporal evolution of procedures frequencies could be used to evaluate the impact on the management of cardiovascular conditions, particularly those infrequent or with high or low mortality which can be postponed. Procedures are coded using the French nomenclature. METHOD: French metropolitan population wit on eimbursment in 2019 (64.3 million) was included from the French National Insurance Database (SNDS). Sds was used to identify in and out patient with a cardiovascular procedure codes (660, 80 groups). Results are presented as [first lockdown 2020/2019 ratio/2019 headcount (‰)/annual 2020/19 and 21/2019 ratios]. RESULTS: Cardiac rhythm and conduction: 12-lead electrocardiogram [59%/103‰/93%; 98%], 24 h continuous electrocardiogram [37%/15‰/92%; 104%], pacemaker implantation [65%/1‰/95%; 100%], defibrillator [61%/0.2‰/96%; 99%], control and adjustment [35%/6.0‰/96%; 101%], interruption of a cardiac pathway [35%/1‰/94%113%], destruction/removal of arrythmogenic tissue [43%/0.1‰/100%; 117%]. Coronary artery disease: exercise test [21%/21‰; 81%; 91%], post-stress test myocardial tomoscintigraphy [35%/5‰/93%; 110%], stress ultrasound [25%/5‰/93%; 123%], coronarography alone [47%/4‰/91%; 100%], stent [63%/153‰/94%; 101%]. Heart valve: replacement [43%/0.2‰/83%; 84%], TAVI [56%/0.2‰/101%; 123%]. Miscellaneous: MAPA (35%/0.5‰/83%; 85%); thoracic aorta replacement (rupture) (65%/0.01‰/112%; 125%), Peripheral extracorporeal circulation [145%/3‰/109%; 115%], thoraco-abdominal circulatory system scan [91%/446‰/119%; 154%], cardiac rehabilitation [14%/27‰/74%; –%]. CONCLUSION: A significant impact was found for various procedures during the first lockdown, as for primary care visit by a GP or a cardiologist. Annual patient levels have returned to 2019 levels in 2020 or exceeded them in 2021. Nevertheless, it remains difficult to estimate the proportion for which a procedure has been missed and still alive or not.