Pandemic Cut U.S. Heart Surgeries in Half as Patients Avoided Hospitals
There has been a sharp decline in heart surgeries and an increase in heart surgery patient deaths in the United States during the COVID-19 pandemic, researchers say.
An analysis of national data revealed a 53% decrease in all adult heart surgeries, including a 40% decline in non-elective heart surgeries and a 65% drop in elective heart surgeries during the pandemic, compared to 2019.
The study was led by Dr. Tom Nguyen, who directs adult cardiothoracic surgery at the University of California, San Francisco (UCSF). He and his colleagues presented the findings Saturday at the annual meeting of the Society of Thoracic Surgeons. Such research is considered preliminary until published in a peer-reviewed journal.
"The pandemic has changed the world as we know it, causing a dramatic drop in adult cardiac surgery volume and worsening patient outcomes," Nguyen said in a meeting news release.
None of this came as a surprise to Dr. Alan Hartman, who directs cardiovascular and thoracic surgery at Northwell Health in Manhasset, N.Y. While COVID-19 has already killed nearly half a million Americans, "buried in those COVID deaths are cardiovascular deaths -- both from the direct effects of a devastating virus preying on a compromised host and by indirect effects, by discouraging people from seeking or acting upon lifesaving medical care needed for cardiovascular disease," Hartman said. He wasn't involved in the new study.
The UCSF team looked at 2020 data from two major databases, involving more than 717,000 adult cardiac surgery patients and over 20 million people with COVID-19.
"Our research also analyzed data by regions, to get an idea of how specific areas did during the COVID pandemic," Nguyen said.
Regionally, some of the largest decreases in heart surgeries occurred in the mid-Atlantic area (New York, New Jersey and Pennsylvania) -- a 71% drop overall, the researchers found. There were 75% fewer elective cases reported, and 59% fewer non-elective (emergency) cases. The New England region was also severely hit, with a 63% overall decrease in heart surgeries.
Before the pandemic surge, the mid-Atlantic and New England regions had excellent outcomes, with lower-than-expected death rates, Nguyen's team noted.
That changed during the pandemic surge: Instead, there was a significant increase for fatal outcomes for all adult heart procedures studied, and that was especially true for people undergoing a bypass operation, the study found.
The data didn't offer insight into the reasons for the increased deaths, but many surgeons say they're currently limited to operating on only the most urgent coronary bypass cases and patients who tend to be sicker to begin with, perhaps skewing the results.
That means that "less sick" heart patients may be avoiding surgery -- and they shouldn't, said Dr. Robbin Cohen, from the Keck School of Medicine at the University of Southern California. He wasn't involved in the study.
"These numbers should not serve as a deterrent to patients seeking care for chest pain or other cardiac symptoms," Cohen said in the release. "If anything, they are a warning to get into the system as soon as possible."
Hartman agreed. He said that many patients who avoided needed heart surgery in 2020 may have died at home.
For example, Hartman said, "during the pinnacle of the surge in New York City, April 7, 2020, EMS data revealed the at-home sudden death rate had skyrocketed to numbers never before seen."
Hartman's advice: "Patients that are experiencing symptoms that may be cardiac-related, or those with known cardiac disease, should proceed with addressing these [symptoms] and not delay or procrastinate. Most hospitals are safe havens, where all patients and all staff are routinely screened and tested for COVID disease and, if found, cared for in units that are separated from the other units, including cardiac surgical areas."
The U.S. National Heart, Lung, and Blood Institute has more on heart surgery.
SOURCES: Alan Hartman, MD, chairman and senior vice president, cardiovascular and thoracic surgery, Northwell Health, Manhasset, N.Y.; Society of Thoracic Surgeons, news release, Jan. 30, 2021