SPC365

COVID-19 impact on referrals, treatment decisions and time on the waiting list for valvular heart disease intervention

Session: Posters (Sessão 1 - Écran 8) - Doença Valvular 1 - Vários
Speaker: Mariana Passos

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana Passos; Carolina Pereira Mateus; Inês Fialho; Joana Lima Lopes; João Baltazar Ferreira; David Roque; Márcio Madeira; João Bicho Augusto; Miguel Santos; Sérgio Bravo Baptista; Pedro Farto e Abreu; Carlos Morais; José Neves

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction: </span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">While a significant impact of COVID-19 on healthcare is well documented, the impact on the specific context of Heart Team (HT) is unknown. The objective of this study was to evaluate how the pandemic may have impacted HT referrals, treatment decisions, time on the waiting list for valvular heart disease (VHD) intervention and major events in this population.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Single center prospective registry of patients (pts) with VHD discussed at the HT meeting between March and December 2020 (COVID-19 period - COV) and a control group from the corresponding period in 2018 (pre-COVID, pCOV). Patients were followed for 12 months. We defined major <span style="color:black">adverse events (MACCE) as a composite of all-cause mortality, stroke, myocardial infarction, hospital readmission due to cardiac causes or worsening heart failure symptoms. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">A total of 151 pts were analyzed (49.0% female, median age 77 [IQR 70-83] years). A numerically inferior number of pts were discussed in the COV period (n=63) as compared with pCOV (n=88)<span style="color:black">. Between April and May 2020, the HT meetings were suspended (Figure 1). </span>There were no significant differences regarding baseline characteristics, except for a higher frequency of aortic valve stenosis and insufficiency in the COV group (p=0.023 and p=0.04, respectively). There were no significant differences on the acceptance rate for intervention (pCOV 94.3% vs COV 96.8%, p=NS). </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">The median waiting time (WT) tend to be higher in the COV period (200 [IQR 103-352] versus 151.5 [IQR 29-335] days, p=0,056), with the pre-specified WT determined during the HT meeting not being accomplished in a significantly higher proportion of COV period patients (85.5 vs 69.1%, p=0.04). </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">The frequency of interventions prioritized as &ldquo;high&rdquo; (due in &lt;15 days) were significantly higher in the pCOV group (23.9 vs 9.5%, p=0.031); conversely, in the COV group a &ldquo;normal priority&rdquo; (due in 45-90 days) was more frequent (69.8% vs 48.9%, p=0.012). Among patients with &ldquo;intermediate&rdquo; priority (due in 15-45 days) there were a significantly higher prevalence of MACCE in the COV group (50 vs 14.3%, p=0.04).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> The impact of the first year of COVID-19 pandemic was two-fold. First, there was a marked reduction in VHD patients referred to the HT meeting, with a coincidentally smaller acceptance rate and increased waiting time for intervention. Second, there was an increase in cardiovascular events among intermediate priority patients. Healthcare agents, and HT doctors in particular, should be aware of these aspects in order to minimize the impact of potential future COVID-19 waves on VHD interventions.</span></span></span></span></p>