Impact of COVID-19 pandemic on rates of congenital heart disease procedures among children: prospective cohort analyses of 26 270 procedures in 17 860 children using CVD-COVID-UK consortium record linkage data

Abstract

Background: The COVID-19 pandemic necessitated major reallocation of healthcare services. Our aim was to assess the impact on paediatric congenital heart disease (CHD) procedures during different pandemic periods compared with the prepandemic period, to inform appropriate responses to future major health services disruptions.

Methods and results: We analysed 26 270 procedures from 17 860 children between 1 January 2018 and 31 March 2022 in England, linking them to primary/secondary care data. The study period included prepandemic and pandemic phases, with the latter including three restriction periods and corresponding relaxation periods. We compared procedure characteristics and outcomes between each pandemic period and the prepandemic period. There was a reduction in all procedures across all pandemic periods, with the largest reductions during the first, most severe restriction period (23 March 2020 to 23 June 2020), and the relaxation period following second restrictions (3 December 2020 to 4 January 2021) coinciding with winter pressures. During the first restrictions, median procedures per week dropped by 51 compared with the prepandemic period (80 vs 131 per week, p=4.98×10^-08). Elective procedures drove these reductions, falling from 96 to 44 per week (p=1.89×10^-06), while urgent (28 vs 27 per week, p=0.649) and life-saving/emergency procedures (7 vs 6 per week, p=0.198) remained unchanged. Cardiac surgery rates increased, and catheter-based procedure rates reduced during the pandemic. Procedures for children under 1 year were prioritised, especially during the first four pandemic periods. No evidence was found for differences in postprocedure complications (age-adjusted OR 1.1 (95% CI 0.9, 1.4)) or postprocedure mortality (age and case mix adjusted OR 0.9 (95% CI 0.6, 1.3)).

Conclusions: Prioritisation of urgent, emergency and life-saving procedures during the pandemic, particularly in infants, did not impact paediatric CHD postprocedure complications or mortality. This information is valuable for future major health services disruptions, though longer-term follow-up of the effects of delaying elective surgery is needed.

Keywords: COVID-19; Electronic Health Records; Heart Defects, Congenital.

Figure 1. Flow chart of study participants from record linkage to the final analysis sample. IMD, Index of Multiple Deprivation; NCHDA, National Congenital Heart Disease Audit; LSOA, Lower Layer Super Output Areas.

Figure 2. The difference is in the weekly median numbers of all, elective, urgent and emergency/life-saving paediatric congenital heart disease procedures comparing pandemic periods to the prepandemic period. Median (IQR) for each restriction/relaxation period compared to the prepandemic period (1 January 2018 to 22 March 2020). Results show the median (IQR) number of all, elective, urgent and emergency or life-saving paediatric procedures per week during the prepandemic and all pandemic periods. P values for the difference between each pandemic period and the prepandemic period were calculated using the Wilcoxon rank test. We combined emergency and life-saving procedures into a single category because of low numbers.

Figure 3. Difference in the mean percentage of each procedure during pandemic periods compared to the prepandemic. Difference in mean percentage estimated in comparison to the prepandemic period (1 January 2018 to 22 March 2020). Results show the difference in mean percentage (95% CI) of the type of procedure compared to all procedures between each period of the pandemic compared to the prepandemic period. We combined diagnostic catheter, electrophysiology and mechanical support procedures into other procedures.

Figure 4. Difference in the mean percentage of the age group of procedure during pandemic periods compared to the prepandemic. Difference in mean percentage for each restriction period estimated from the prepandemic period (1 January 2018 to 22 March 2020). Results show the difference in mean percentage (95% CI) of procedure among different age groups between each period of the pandemic compared to the prepandemic period.

Figure 5. ORs of urgency, postprocedure complications and mortality within 30 days of a procedure comparing pandemic periods to the prepandemic period. OR (95% CI) estimated in comparison to the prepandemic period (1 January 2018 to 22 March 2020). Results show the age-adjusted ORs of urgent/emergency/life-saving procedure versus elective, postprocedure complications (yes vs no) and age, and age plus case mix adjusted odds of mortality within 30 days of a procedure (yes vs no) during different periods of the pandemic compared with the prepandemic period. We combined urgent, emergency and life-saving procedures into a single category.