The Effect of Coronavirus Outbreak on the Utilization of Coronary Revascularization Procedures: An Interrupted Time
Antonio Sarria-Santamera1, Alexandr Petrov1, Dinara Yessimova1
1Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan.
Insights
The COVID-19 pandemic reduced coronary revascularization rates in Spain, increasing the risk profile for coronary artery bypass graft (CABG) patients. This trend toward higher-risk patients began before the pandemic.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic significantly strained healthcare systems globally.
- Programmed interventions like coronary revascularization were postponed, particularly during the pandemic's initial wave in Spain.
- The exact impact of delayed coronary revascularization procedures remains unclear.
Purpose of the Study:
- To evaluate changes in the utilization rates and patient risk profiles for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) before and after March 2020.
- To assess the impact of the COVID-19 pandemic's first wave on coronary revascularization procedures in Spain.
Main Methods:
- Interrupted time series (ITS) analysis was employed.
- Data from the Spanish National Hospital Discharge Database (SNHDD) were utilized.
- Patient risk profiles and procedure rates for PCI and CABG were compared across pre- and post-March 2020 periods.
Main Results:
- The first wave of COVID-19 in Spain led to a reduction in coronary revascularization cases.
- A notable increase in the risk profile was observed for patients undergoing CABG, but not PCI.
- A pre-existing trend of increasing patient risk profiles for both PCI and CABG was identified prior to the pandemic.
Conclusions:
- The COVID-19 pandemic's initial impact in Spain altered coronary revascularization utilization and patient risk stratification.
- While CABG patients showed an increased risk profile post-pandemic onset, this trend was already emerging.
- Further research using diverse datasets and regions is recommended to validate these findings.
Abstract:
The coronavirus disease 19 (COVID-19) pandemic represented a great challenge for health systems, which had to quickly readapt and dedicate most of their resources to managing this crisis. The postponement of programmed interventions such as coronary revascularization procedures represented a critical issue in the first wave of the COVID-19 pandemic, especially in the hardest-hit countries such as Spain. However, the precise consequences of the delay of coronary revascularizations are not clearly determined. In the present work, interrupted time series (ITS) analysis was used to evaluate the utilization rates and assessment of the risk profiles of patients receiving two main coronary revascularization procedures (percutaneous coronary intervention-PCI and coronary artery bypass graft-CABG) and compared them in the periods before and after March 2020 using the Spanish National Hospital Discharge Database (SNHDD). Our results show that the abrupt reorganization of hospital care that represented the first wave of COVID-19 in March 2020 in Spain led to a reduction in cases, which was accompanied by an increase in the risk profile of CABG patients, but not PCI. On the other hand, the risk profile of both coronary revascularization procedures began before the pandemic, showing a significant temporal trend toward an increase in the risk profile. Future works should be directed to study and validate our results, evaluating other databases, regions, or countries.
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