Procedure deferrals during COVID-19 pandemic may affect clinical practice, CV events
Cardiac procedural deferrals during the COVID-19 pandemic were linked with the severity of hospital COVID-19 burden and procedural urgency, according to the results of a survey of cath lab directors and interventional cardiologists.
Interventional cardiologists also reported increases in patients with STEMI presenting late during the pandemic, even in institutions that did not have high COVID-19 burden, according to the results published in Catheterization and Cardiovascular Interventions.
“This suggests that patient fears may be driving behaviors more than actual risk,” Celina M. Yong, MD, MBA, MSc, assistant professor of medicine at Stanford University School of Medicine and director of interventional cardiology at VA Palo Alto Hospital in California, told Healio.
Impact of procedure deferrals
Since the start of the COVID-19 pandemic, several cardiology societies issued advisories to ensure optimal safety of patients and hospital personnel in the cardiac catheterization laboratory. The American College of Cardiology and the Society for Cardiovascular Angiography and Interventions issued a statement on March 17 with initial recommendations, particularly that deferring elective procedures is sensible during the pandemic. More specific recommendations were published on March 25 by a team of SCAI’s Emerging Leader Mentorship members and graduates.
To assess the effect of cardiac procedural deferrals during the pandemic, researchers administered a web-based survey in May.
“In collaboration with SCAI and the ACC Interventional Council, we conducted a study of cath lab directors and interventionalists from across the U.S. to get a better understanding of how these deferrals have been practically implemented across the U.S. and what the impacts might be on patients during the early stages of this pandemic,” Yong said in an interview.
Researchers received 414 responses from 360 unique cardiac catheterization laboratories in 48 states. The mean COVID-19 burden from the cath labs was 16.4%. The spectrum of deferral by procedure type varied by procedural urgency and the burden of COVID-19 (P < .001).
As procedures were deferred during the pandemic, volumes of PCI decreased by 55% (P < .0001) and volumes of transcatheter aortic valve replacement by 64% (P = .004). In addition, nearly 40% of directors of cardiac cath labs reported an increase in late-presenting STEMI and nearly 20% of directors reported increases in deaths as patients waited to undergo TAVR.
At least one interventional cardiologist tested positive for COVID-19 in 29% of cardiac catheterization laboratories in this study.
Although nearly half of directors reported a salary reduction as a result of COVID-19, it did not influence the degree of angiogram/PCI deferral or the speed in which laboratories reinstituted normal operations.
From the pre- and post-COVID-19 period, preparedness ratings for a pandemic or major disaster significantly increased in cardiac catheterization laboratories. Cardiologists used new types of information sources during the pandemic to help guide clinical practice. Despite this increase in preparedness, interventional cardiologists reported that they anticipate future challenges, including staff health risks and access to COVID-19 testing.
“The most immediate impact [from these findings] is that physicians can focus their attention now on making sure that patients who need cardiovascular treatment aren’t afraid of coming to the hospital out of fear of COVID-19, especially with all the safety precautions we now have in place,” Yong told Healio. “While we don’t yet have all the answers for treating COVID-19, we do have proven, lifesaving treatments for heart attacks and many other cardiovascular diseases, but if patients aren’t getting those treatments, then the lives lost due to this pandemic will stretch far beyond just those from the virus itself.”
Further research
Yong said more research is needed to learn more about the true effects of the large-scale deferral of CV procedures, although the COVID-19 pandemic provides unique research opportunities.
“COVID-19 has produced an unprecedented natural experiment that will demonstrate the comparative effectiveness of a vast number of procedures,” Yong told Healio. “This information can guide future decisions on usefulness of therapies in a way that traditional randomized controlled trials will probably never accomplish.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.
For more information:
Celina M. Yong, MD, MBA, MSc, can be reached at cyong@stanford.edu.
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