Cardiac operations and interventions during the COVID-19 pandemic: a nationwide perspective

Abstract

Aims: The COVID-19 pandemic has led to a decline in hospitalizations for non-COVID-19-related conditions. We explored the impact of the COVID-19 pandemic on cardiac operations and interventions undertaken in England.

Methods and results: An administrative database covering hospital activity for England, the Health Episodes Statistics, was used to assess a total of 286 697 hospitalizations for cardiac operations and interventions, as well as 227 257 hospitalizations for myocardial infarction (MI) and 453 799 for heart failure (HF) from 7 January 2019 to 26 July 2020. Over the 3 months of 'lockdown', total numbers and mean reductions in weekly rates [n (-%)], compared with the same time period in 2019, were: coronary artery bypass grafting [-2507 (-64%)]; percutaneous coronary intervention [-5245 (-28%)]; surgical [-1324 (-41%)] and transcatheter [-284 (-21%)] aortic valve replacement; mitral valve replacement; implantation of pacemakers [-6450 (-44%)], cardiac resynchronization therapy with [-356 (-42%)] or without [-491 (-46%)] defibrillation devices, and implantable cardioverter-defibrillators [-501 (-45%)]; atrial fibrillation ablation [-1902 (-83%)], and other ablations [-1712 (-64%)] (all P < 0.001). Over this period, there were 21 038 fewer procedures than in the reference period in 2019 (P < 0.001). These changes paralleled reductions in hospitalizations for MI [-10 794 (-27%)] and HF [-63 058 (-28%)] (both P < 0.001).

Conclusions: The COVID-19 pandemic has led to substantial reductions in the number of cardiac operations and interventions undertaken. An alternative strategy for healthcare delivery to patients with cardiac conditions during the COVID-19 pandemic is urgently needed.

Keywords: Aortic valve replacement; COVID-19; Cardiac ablation; Cardiac resynchronization therapy; Heart failure; Implantable cardioverter-defibrillator; Mitral valve replacement; Myocardial infarction; Pacemaker; Transcatheter aortic valve implantation.

Figure 1

Number of cardiac operations and interventions in hospitalizations undertaken in England during the COVID-19 pandemic. Dashed horizontal lines indicate the mean weekly rate of procedures during the reference period in 2019. Mean and 95% CI are shown above the lines. The black, vertical, dashed line marks the announcement of the national ‘lockdown’ on 23 March 2020. AF, atrial fibrillation; AVR, surgical aortic valve replacement; CABG, coronary artery bypass graft; CRT-D, cardiac resynchronization therapy-defibrillation; CRT-P, cardiac resynchronization therapy-pacing; ICD, implantable cardioverter-defibrillator; MVR, mitral valve replacement; PCI, percutaneous coronary intervention; PPM, permanent pacemaker; TAVI, transcatheter aortic valve implantation.

Figure 2

Number of cardiac operations and interventions during the COVID-19 pandemic. Graphs show (A) mean per cent (SD) change in the weekly number and (B) change in the total number of cardiac operations and interventions during the 3 months of lockdown. In (A), changes in relation to reference period in 2019 were all statistically significant (P < 0.001). AF, atrial fibrillation; AVR, surgical aortic valve replacement; CABG, coronary artery bypass graft; CRT-D, cardiac resynchronization therapy-defibrillation; CRT-P, cardiac resynchronization therapy-pacing; ICD, implantable cardioverter-defibrillator; MVR, mitral valve replacement; PCI, percutaneous coronary intervention; PPM, permanent pacemaker; TAVI, transcatheter aortic valve implantation.

Figure 3

Number of cardiac operations and interventions during the COVID-19 pandemic according to hospitalization type. Graphs show (A) mean per cent (SD) change in the weekly number and (B) change in the total number of cardiac operations and interventions during the 3 months of lockdown, according to hospitalization type (emergency or elective). In (A), changes in relation to the same time period in 2019 were all significant (P < 0.001), for both emergency and elective hospitalizations. In the case of emergency ablation for conditions other than atrial fibrillation, but weekly rate was highly variable (median reduction: −7.14%; interquartile range −31.6 to 16.7). AF, atrial fibrillation; AVR, surgical aortic valve replacement; CABG, coronary artery bypass graft; CRT-D, cardiac resynchronization therapy-defibrillation; CRT-P, cardiac resynchronization therapy-pacing; ICD, implantable cardioverter-defibrillator; MVR, mitral valve replacement; PCI, percutaneous coronary intervention; PPM, permanent pacemaker; TAVI, transcatheter aortic valve implantation.

Figure 4

Hospitalizations for myocardial infarction and heart failure in England during the COVID-19 pandemic. Graphs show weekly numbers of hospitalizations. Dashed horizontal lines indicate the mean weekly number of hospitalizations during the reference period in 2019. Mean (95% CI) are shown above the lines. The black, vertical, dashed line marks the announcement of the national ‘lockdown’, on 23 March 2020. Changes in weekly rates in relation corresponding weeks during the reference period in 2019 were all statistically significant (P < 0.001).

Figure 5

Per cent reduction in weekly number of cardiac operations and interventions during the COVID-19 pandemic. Graph shows mean percent (SD) reduction in the weekly number of cardiac operations and interventions during the 3 months of lockdown. AF, atrial fibrillation; AVR, surgical aortic valve replacement; CABG, coronary artery bypass graft; CRT-D, cardiac resynchronization therapy-defibrillation; CRT-P, cardiac resynchronization therapy-pacing; ICD, implantable cardioverter-defibrillator; MVR, mitral valve replacement; PCI, percutaneous coronary intervention; PPM, permanent pacemaker; TAVI, transcatheter aortic valve implantation.