Massive drop in elective and urgent aortic procedures during the peak of the COVID-19 outbreak in Spanish multicenter analysis

Valdivia, Andrés Reyes; Norberto, Enrique San; Moreno, Rosa María Girón; Febres, L.M. Salmerón; Miralles, Manuel; López, I. Martínez; Zanabili, Amer; Fajardo, J. A. González; Gandarias, Claudio; Haro, Joaquín De; Alonso, Manuel Francisco García

doi:10.1016/j.jvs.2020.08.027

Cited by 9 publications

(7 citation statements)

References 3 publications

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“…Currently, the reasons remain speculative but reluctance of patients to seek advice or a natural undulation in the incidence might be causative [ 8 ]. But in some epicentres of the COVID-19 pandemic a dramatic decrease in patients treated for acute aortic disease could also be seen [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Czerny

Gottardi

Puiu

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89–1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76–0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (−40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Czerny

Gottardi

Puiu

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…Cardiovascular procedural care, although frequently considered urgent or emergent, has likewise experienced a significant decrease in volume. 1 , 2 Recent reports from Asia, the United States, and Europe have highlighted not only the lost volume of procedures, but also delays in care for time-sensitive cardiovascular conditions, such as acute myocardial infarction. 3 – 6 Similar effects have been observed anecdotally within our health system and state.…”

mentioning

confidence: 99%

Elective Surgical Delays Due to COVID-19

Byrnes¹,

Brown²,

Roo³

et al. 2021

Medical Care

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Background: This qualitative research explored the lived experiences of patients who experienced postponement of elective cardiac and vascular surgery due to coronavirus disease 2019 (COVID-19). We know very little about patients during the novel coronavirus pandemic. Understanding the patient voice may play an important role in prioritization of postponed cases and triage moving forward. Methods: Utilizing a hermeneutical phenomenological qualitative design, we interviewed 47 individuals who experienced a postponement of cardiac or vascular surgery due to the COVID-19 pandemic. Data were analyzed and informed by phenomenological research methods. Results: Patients in our study described 3 key issues around their postponement of elective surgery. Patients described robust narratives about the meanings of their elective surgeries as the chance to “return to normal” and alleviate symptoms that impacted everyday life. Second, because of the meanings most of our patients ascribed to their surgeries, postponement often took a toll on how patients managed physical health and emotional well-being. Finally, paradoxically, many patients in our study were demonstrative that they would “rather die from a heart attack” than be exposed to the coronavirus. Conclusions: We identified several components of the patient experience, encompassing quality of life and other desired benefits of surgery, the risks of COVID, and difficulty reconciling the 2. Our study provides significant qualitative evidence to inform providers of important considerations when rescheduling the backlog of patients. The emotional and psychological distress that patients experienced due to postponement may also require additional considerations in postoperative recovery.

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“…Of note, pacemaker implantations following aortic valve interventions were excluded in this analysis indicating a true reduction of emergency admission for severe bradycardia. Interestingly, even in the field of acute aortic syndromes requiring surgery there were marked decreases in patient numbers reported from both Europe to the US 32,33 . Regardless of this, treatment numbers in cardiac surgery were reduced by ~50% up to 75% both in areas with low and even pronounced in those with high COVID‐19 case numbers 34 .…”

Section: Discussionmentioning

confidence: 99%

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

König

Ueberham

Pellissier

et al. 2021

Clinical Cardiology

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Background Treatment numbers of various cardiovascular diseases were reduced throughout the early phase of the ongoing COVID‐19 pandemic. Aim of this study was to (a) expand previous study periods to examine the long‐term course of hospital admission numbers, (b) provide data for in‐ and outpatient care pathways, and (c) illustrate changes of numbers of cardiovascular procedures. Methods and Results Administrative data of patients with ICD‐10‐encoded primary diagnoses of cardiovascular diseases (heart failure, cardiac arrhythmias, ischemic heart disease, valvular heart disease, hypertension, peripheral vascular disease) and in‐ or outpatient treatment between March, 13th 2020 and September, 10th 2020 were analyzed and compared with 2019 data. Numbers of cardiovascular procedures were calculated using OPS‐codes. The cumulative hospital admission deficit (CumAD) was computed as the difference between expected and observed admissions for every week in 2020. In total, 80 hospitals contributed 294 361 patient cases to the database without relevant differences in baseline characteristics between the studied periods. There was a CumAD of −10% to −16% at the end of the study interval in 2020 for all disease groups driven to varying degrees by both reductions of in‐ and outpatient case numbers. The number of performed interventions was significantly reduced for all examined procedures (catheter ablations: −10%; cardiac electronic device implantations: −7%; percutaneous cardiovascular interventions: −9%; cardiovascular surgery: −15%). Conclusions This study provides data on the long‐term development of cardiovascular patient care during the COVID‐19 pandemic demonstrating a significant CumAD for several cardiovascular diseases and a concomitant performance deficit of cardiovascular interventions.

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Massive drop in elective and urgent aortic procedures during the peak of the COVID-19 outbreak in Spanish multicenter analysis

Cited by 9 publications

References 3 publications

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

Elective Surgical Delays Due to COVID-19

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

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