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.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Protocols
https://github.com/BHFDSC/CCU007_01/Protocol
Funding Statement
The British Heart Foundation Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser National Core Studies program to coordinate national COVID-19 priority research. Consortium partner organizations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This study was funded by the British Heart Foundation (AA/18/1/34219) and Bristol National Institute for Health Research Biomedical Research Centre. GA (R104281-102) MC(CH/17/1/32804) and DAL(CH/F/20/90003) contributions are supported by their British Heart Foundation Chairs. AKS and DAL contribution is further supported by DAL National Institute for Health Research Senior Investigator Award ((NF-0616-10102). AKS, VW, and DAL work in, or are affiliated with, the UK Medical Research Council Integrative Epidemiology Unit (MC_UU_00032/03 and MC_UU_00032/05). RD and VW received support from the Longitudinal Health and Wellbeing COVID-19 National Core Study, which was established by the UK Chief Scientific Officer in October 2020 and funded by UK Research and Innovation (grant references MC_PC_20030 and MC_PC_20059) and from the CONVALESCENCE study of long COVID-19 funded by National Institute for Health and Care Research (NIHR)/UK Research and Innovation.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The North East - Newcastle and North Tyneside 2 research ethics committee provided ethical approval for the CVD-COVID-UK/COVID-IMPACT research programme (REC No 20/NE/0161)
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data Availability
The data used in this study are available in NHS England Secure Data Environment service for England, but as restrictions apply they are not publicly available. Those wishing to gain access to the data should contact British Heart Foundation Data Science Centre in the first instance.
https://digital.nhs.uk/services/secure-data-environment-service
