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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%], 24h 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.
ABSTRACT
Introduction During the COVID-19 pandemic, healthcare use has been challenged and several implications regarding the incidence and management of cardiovascular diseases and their risk factors were found. Objective This study examines time trends in the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population. Method For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for the medications of interest but no reimbursement in the previous 12months. We computed crude and age-standardized rates along with incidence rate ratios (IRRs) between 2017–2019 and respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019-time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists. Results In 2020, IRR significantly decreased for initiations of antihypertensives (−11%), lipid-lowering drugs (−5%), oral anticoagulants in atrial fibrillation (−9%), and smoking cessation medications (−52%) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+12%) but even lower rates for the other medications, particularly in women. Besides, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4% and 7.4%, respectively, with a higher decrease observed in those over 65years and a greater use of teleconsultations in women. Conclusion The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65years.
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Déclaration de liens d'intérêts : Les auteurs déclarent ne pas avoir de liens d'intérêts.
ABSTRACT
Déclaration de liens d'intérêts : Les auteurs déclarent ne pas avoir de liens d'intérêts.
ABSTRACT
Objective: The objective was to analyze time-trends in the rates of patients who had at least one reimbursement of an antihypertensive drug without reimbursement in the past 12 month for each year from 2017 to 2021, and to study changes according to sex, age, history of cardiovascular diseases, group of antihypertensive drugs and lockdown/curefew periods. Design and method: We used data from the French national healthcare database (“Systéme National des données De Santé”-SNDS) covering 99% of the French population. For each year and weeks from 1st January 2017 to 23 of May 2021, patients who initiated an antihypertensive drug treatment in France were selected. Crude and age-standardized rates of patients initiating an antihypertensive drug in overall population living in France were calculated and compared with the 2017-2019 incidence with incidence rate ratio (IRR) adjusted for age and time-trends. Consultations (with general practitioner (GP) or cardiologist) were also recorded over the study period Results: In 2020, 1,518,686 persons initiated an antihypertensive therapy in France which was less than the mean number 2017-2019 (n = 1,549,215). The age-standardized incidence in the French population were 2.2% for 2017, 2.3% for 2018, 2.4% for 2019 and 2.2% for 2020. The initiation of an antihypertensive treatment declined by 11% in 2020 as compared to 2017-2019 (reaching -30% during the first national lockdown), with a major differences between men (-5%) and women (-16%), and age groups (-2% in people aged < 45 years old, and -17% in more than 85 years). A similar decline was found between people with a personal history of cardiovascular disease and those without. Among antihypertensive treatments, the greater decrease in the initiation was observed for diuretics (-20%) and ARBs (-19%). In 2021, initiation of antihypertensive drugs were still diminished compared to 2017-2019 but in a lower extent (-4%). An increase was even observed in the youngest age group (+6%) and in men (+4%). Conclusions: The pandemic had a major impact on the initiation of antihypertensive drugs and therefore the incidence and/or screening of hypertension with an important age and sex effect and no catch-up effect was observed in 2021.