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 re-allocation of health care services. Our aim was to assess the impact on pediatric procedures for congenital heart disease during different periods of the COVID-19 pandemic compared to the pre-pandemic period to inform appropriate responses to future major disruptions of health services. Methods and Results We used data on 26,270 procedures from 17,860 children between 01st January 2018 and 31st March 2022 in England and linked them to the primary/secondary care data to obtain the basic demographic information. We compared characteristics of procedures and outcomes between different periods of population restrictions, and relaxation of those, with the pre-pandemic period. There was a reduction in all procedures across all pandemic periods. These varied in magnitude with the largest magnitudes seen in the first, and most severe period of restrictions, and the period of relaxation following the second restrictions, which coincided with winter pressures. For example, there was a reduction of 51 median procedures per week, during the first period of restrictions (3rd March 2020 to 23rd June 2020) compared with the pre-pandemic period (1st January 2018 to 22nd March 2020): 80/week vs 131/week, p = 4.98 x 10-08). The reductions in procedures were driven by reductions in elective procedures. In the first period of restrictions these fell from median 96/week to 44/week, (p = 1.89 x 10-06), with urgent (28/week vs 27/week, p = 0.649) and life-saving / emergency procedures (7/week vs 6/week, p = 0.198) not changing. Cardiac surgery rates increased, and catheter-based procedure rates decreased during pandemic periods compared to the pre-pandemic period and there was evidence that procedures in those younger than 1-year were prioritized, particularly during the first four pandemic periods. We did not find evidence of differences in post procedure complications (age adjusted odds ratio 1.1 (95%CI: 0.9, 1.4) or post procedure mortality (age and case mix adjusted odds ratio 0.9 (0.6, 1.3)). Conclusions Reductions in elective procedures and prioritization of urgent, emergency and life-saving procedures during the pandemic did not impact pediatric CHD post procedure complications or mortality. This is informative for future major disruptions of health services, though longer-term follow-up of the effects of delaying elective surgery is needed.