Cardiovascular procedural deferral and outcomes over COVID-19 pandemic phases: A multi-center study.
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ABSTRACT: Background
The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations.Methods
Cardiovascular procedures performed at 30 hospitals across 6 Western states in 2 large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression.Results
Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in 2 distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15-April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (P = .0003), older (P < .0001), Asian or Black (P = .02), or Medicare insured (P < .0001), and COVID I procedures were higher acuity (P < .0001), but not higher complexity. In COVID II, there was a trend toward more procedural deferral in regions with a higher COVID-19 burden (P = .05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases.Conclusions
Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.
SUBMITTER: Yong CM
PROVIDER: S-EPMC8233406 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC8220935 | biostudies-literature
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| S-EPMC8475474 | biostudies-literature
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| S-EPMC8704736 | biostudies-literature
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| S-EPMC8443913 | biostudies-literature
Project description:Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care. Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group. Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018-2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018-2019 (p = 0.0165, Fisher's exact test). Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.
| S-EPMC8138624 | biostudies-literature
Project description:BackgroundThere are serious concerns regarding the effectiveness of medical education in its current format during serious crises like the COVID-19 pandemic.ObjectiveTo explore academic, financial, psychological, & hygienic impact on medical students.MethodsA cross-sectional, questionnaire-based study of students at different medical schools in Jordan. It included both basic and clinical years.ResultsThere were 415 responses. Females constituted 51.8%. Around 50% of the participants were from the 6th year (n = 194, 46.7%). University of Jordan students represented around 40% of the responders. 60% of the students have GPA (Grade Point Average) of less than 3 points. Nearly half of the students indicated that their academic grades were affected during the pandemic. Clinical years' students (51.0%) were more likely to be negatively affected than students in basic years (36.1%), P value 0.026. Sixty three percent reported that they sanitize their hands before touching eyes, nose, or mouth. More than two thirds (70.4%) of students indicated that their mental health was affected in the pandemic. Financial influence was a major aspect in around 53% of students and 34% of students were not able to pay the university fees due to the pandemic. The pandemic affected the elective training course location of 70.9% of respondents. Mental health was affected in 70.9% of students and 65.1% became more anxious or depressed with no significant difference among gender and academic years (P values 0.256 and 0.516, respectively). Students in the clinical years were more afraid of getting the infection than students in the basic years, however this difference was not statistically significant (p = 0.084).ConclusionsCovid-19 Pandemic negatively affected the academic course of the medical students especially at the clinical training years' level across Jordanian universities. COVID-19 pandemic left a negative impact on psychological & mental health of the students, too, rendering them more anxious, depressed, and afraid of coming to the hospital and handling patients.
| S-EPMC8209674 | biostudies-literature