The unpredictability of the SARS-CoV-2 outbreak posed a huge challenge to healthcare systems worldwide. Fearing a surge for high care hospital beds for COVID-19-patients, scheduled elective interventions were deferred. However, the effects of this measure on patients’ outcomes have not been evaluated, yet.
Purpose:
To investigate the effects of the deferral of scheduled interventions on the time to emergency heart failure hospitalization or death, course of symptoms, cardiac biomarkers, and left ventricular systolic function after 12 months.
Methods:
We conducted a retrospective observational study including consecutive patients treated at our tertiary care center, whose scheduled elective heart valve interventions (transcatheter aortic valve replacement, transcatheter mitral- and tricuspid valve repair) were deferred between March 19th and April 30th 2020 (study group). Patients who underwent the heart valve intervention as scheduled during the same period in 2019 served as the control group. The primary endpoint was a composite of the time to emergency heart failure hospitalization or death, secondary endpoints were clinical parameters of heart failure such as NYHA-class, NT-proBNP levels, and left ventricular systolic function.
Results:
Outcomes of 45 patients whose heart valve interventions were deferred in the initial phase of the COVID-19 pandemic and of 40 patients who underwent the elective intervention as scheduled in 2019 were compared. Remarkably, the primary endpoint was significantly increased in the study group (HR 11.58 95 %, CI 3.48-38.59, p<0.001). Additionally, while there were no significant differences at baseline, after 12 months of follow-up clinical symptoms as assessed by NYHA-class (study group: 1.7±0.9 control group: 1.5±0.7; p=0.002), and serum NT-proBNP-levels (study group: 3252 (1982, 5070) pg/ml; control group: 795 (548, 2178) pg/ml, p=0.023), were significantly worse in the study group.
Conclusion:
Here we show for the first time that deferral of patients with a scheduled heart valve intervention is associated with a high rate of early emergency heart failure hospitalizations in the subsequent 12 months, emphasizing the importance of timely medical treatment in this population. Consequently, deferral should be indicated as cautious as possible.
https://dgk.org/kongress_programme/ht2021/P92.htm