TRACKING CIRRHOSIS CARE DURING COVID-19 PANDEMIC

ABSTRACT

Background and Aims: The COVID-19 pandemic has resulted in profound disruptions in the delivery of health care. These disruptions have disproportionately impacted patients with complex diseases, such as cirrhosis. This study aimed to evaluate the impact of the COVID-19 pandemic on the implementation of high-value care among veterans with cirrhosis. Method: All US Veterans with cirrhosis who were enrolled in VA health care in the fiscal year 2019 were identified using ICD-10-CM codes. This cohort was then followed through the end of the fiscal year 2021. Quarterly outcomes measured included every 6- months HCC screening (HCC-6), endoscopic variceal surveillance or treatment with nonselective beta-blockers (EVST), and all-cause hospitalizations. Joinpoint trend analysis was used to identify the time point at which health care measures declined during the pandemic. Multivariate logistic regression was used to compare pre-and post-COVID care, using January 2020 (onset of COVID pandemic) as the cutpoint. Results: There were 71,552 veterans with cirrhosis in VA care in 2019. This cohort was 96% male, with a median age of 66 (IQR 61-70), and predominantly alcohol- or hepatitis C-related cirrhosis (Table 1). Over the following 3 years, 22,043 were censored due to death, withdrawal from the VA, or liver transplantation. HCC-6, which was stable at an average of 38% before COVID-19, had a sharp decline in the early phase of COVID-19 to a nadir of 31% (p<0,01) and is now gradually recovering (Figure 1A). Although the rates of EVST were decreasing before COVID- 19 onset, they dropped precipitously starting in 2020-Q1 and have not yet recovered (Figure 1B), with the rate of 49% dropping to 43% (p<0.01). There was no clear point at which hospitalization changed in the joinpoint analysis, though this measure has decreased slowly during COVID-19 from a 7.6% quarterly admission rate to 5.8% during the pandemic (Figure 1C). Similarly, on multivariate analysis, the odds of HCC-6 (0.68[0.63-0.65]), EVST (0.58[0.56-0.61]) and hospitalization (0.85[0.83-0.87]) were all lower during the COVID- 19 period. Conclusion: Despite the ongoing COVID-19 pandemic, HCC surveillance is recovering in VA. However, EVST rates remain low. Further research is needed to understand the decrease in hospitalization for patients with cirrhosis and identify measures to improve cirrhosis care. (Table Presented) (Figure Presented)