ABSTRACT
BACKGROUND: The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures. METHODS: Clinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures. RESULTS: We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period. CONCLUSIONS: There was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization.
Subject(s)
COVID-19 , Cardiovascular Diseases , Coronary Artery Bypass/statistics & numerical data , Delayed Diagnosis , Percutaneous Coronary Intervention/statistics & numerical data , Transcatheter Aortic Valve Replacement/statistics & numerical data , Waiting Lists/mortality , COVID-19/epidemiology , COVID-19/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Cardiovascular Diseases/psychology , Cardiovascular Diseases/surgery , Delayed Diagnosis/psychology , Delayed Diagnosis/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Female , Humans , Infection Control/methods , Male , Middle Aged , Mortality , Ontario/epidemiology , SARS-CoV-2 , Time-to-Treatment/organization & administrationSubject(s)
COVID-19 , Delayed Diagnosis , Early Detection of Cancer/statistics & numerical data , Neoplasms/prevention & control , Patient Acceptance of Health Care , SARS-CoV-2 , Asymptomatic Diseases , COVID-19/prevention & control , COVID-19/psychology , Cell Transformation, Viral , Delayed Diagnosis/prevention & control , Delayed Diagnosis/psychology , Delayed Diagnosis/statistics & numerical data , Health Education , Health Promotion , Humans , Incidence , National Cancer Institute (U.S.) , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/etiology , Obesity/complications , Obesity/epidemiology , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Research , SARS-CoV-2/pathogenicity , Self Care , Societies, Medical , Specimen Handling , United StatesSubject(s)
Anemia, Iron-Deficiency/diagnosis , COVID-19/psychology , Delayed Diagnosis/psychology , Pandemics , SARS-CoV-2 , Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/therapy , Erythrocyte Transfusion , Fear , Female , Humans , Leiomyoma/complications , Leiomyoma/diagnosis , Middle Aged , Syncope/etiology , Uterine Hemorrhage/complications , Uterine Neoplasms/complications , Uterine Neoplasms/diagnosisSubject(s)
Attitude to Health , COVID-19 , Delayed Diagnosis/psychology , Pandemics , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Patients/psychology , SARS-CoV-2 , Skin Neoplasms/psychology , Aged , Aged, 80 and over , Appointments and Schedules , Carcinoma/diagnosis , Carcinoma/psychology , Cross-Sectional Studies , Disease Progression , Early Detection of Cancer , Emergency Service, Hospital/statistics & numerical data , Fear , Female , Health Services Accessibility , Humans , Keratoacanthoma/diagnosis , Keratoacanthoma/psychology , Male , Melanoma/diagnosis , Melanoma/psychology , Neoplasm Recurrence, Local/diagnosis , Quarantine , Referral and Consultation , Skin Neoplasms/diagnosis , Surveys and Questionnaires , TelemedicineABSTRACT
OBJECTIVE: The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes. STUDY DESIGN: This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019. RESULTS: During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly (p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups. CONCLUSION: The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel. KEY POINTS: · Less obstetrical ER attendance is observed during the pandemic.. · There is a parallel increase in stillbirth rate.. · Stillbirth cases tested negative for COVID-19.. · Lockdown and pandemic panic are possible causes..