Lessons for Treating Structural Heart Patients during the COVID-19 Pandemic and Beyond

Area of Science:

• Cardiology
• Interventional Cardiology
• Public Health

Background:

• The Coronavirus Disease 2019 (COVID-19) pandemic significantly impacted healthcare delivery, necessitating adaptations in patient care.
• Structural heart disease (SHD) procedures were modified, with elective cases canceled and urgent procedures prioritized during the pandemic's peak.
• Practice changes were implemented to minimize complications, prevent COVID-19 transmission, and reduce hospital stays for SHD patients.

Purpose of the Study:

• To compare the characteristics and outcomes of SHD patients treated during the COVID-19 pandemic (
• COVID era" ) with historical controls.
• To evaluate the effectiveness of practice changes implemented during the COVID era in managing SHD patients.
• To determine if these practice changes can be sustained in the post-COVID era.

Main Methods:

• A comparative study design was employed, analyzing data from SHD patients treated during the COVID era and the same period in 2019.
• Baseline characteristics and procedural outcomes were collected for all patients undergoing SHD procedures.
• Statistical analysis was performed to compare patient groups and identify significant differences in outcomes.

Main Results:

• SHD patients during the COVID era (N = 26) presented with higher left ventricular end-diastolic pressure (LVEDP) and were more frequently New York Heart Association class IV compared to 2019 controls (N = 259).
• Despite more severe illness, the COVID era group experienced a significantly lower rate of bleeding/vascular complications (0% vs. 16.2%) and permanent pacemaker implantation (0% vs. 17.4%).
• A greater proportion of patients were discharged on post-operative day 1 (POD#1) in the COVID era (68.2% vs. 22.2%).

Conclusions:

• Practice modifications during the COVID era resulted in fewer vascular complications, reduced pacemaker implantation rates, and earlier discharge for SHD patients, even with increased illness severity.
• These findings demonstrate the successful adaptation of care pathways in response to the pandemic.
• The study supports the continuation of these beneficial practice changes in the post-COVID era for structural heart disease management.