Heart surgeries fell amid pandemic

Heart surgeries among adults in the United States dropped by 53 percent amid the coronavirus pandemic last year compared with the year before, prompting concern among cardiac surgeons that many patients put off crucial surgery over fears they could catch the virus.

The research findings released at a meeting of the Society of Thoracic Surgeons (STS) in January also showed that there was a rise in deaths after patients had coronary artery bypass grafting. It is not yet known why that happened.

Nationwide, adult cardiac surgeries fell to roughly 12,000 a month, a drop of half compared with the same time in 2019. The researchers examined data from 717,103 heart surgery patients and more than 20 million coronavirus patients.

Dr Robbin Cohen, professor of surgery at the KECK School of Medicine at the University of Southern California in Los Angeles told China Daily: “The fall in heart surgeries is totally linked to the pandemic. It’s due to a combination of things. When hospitals got overrun with COVID patients, they shut down their elective surgeries and they also shut down their diagnostic work that cardiologists did. So, fewer people were getting diagnosed with heart disease.

“Number two, fewer people were allowed to have treatment for heart disease because they couldn’t get them into the hospital unless they were absolutely emergencies,” Cohen said. “When I talked to my colleagues throughout the country, we’ve all been in the same boat for many months; we were reduced to doing nothing but emergencies.”

More than 500,000 people in the US have died from COVID-19, and more than 28.2 million have been infected with the coronavirus. But hospitalizations are falling.

At the height of the pandemic in April and May 2020, many patients with other health conditions, such as heart disease, feared visiting a hospital.

“The sad fact is many of those people simply died while avoiding hospital care for their cardiac disease,” Dr Vivek Rao, chief of cardiovascular surgery at Toronto General Hospital said at a media briefing.

Rao said that cardiac surgeons in Canada had expected to see hundreds if not thousands of patients show up for surgery by June 2020, but that didn’t happen.

Many patients had to be called about their appointments and reassured that hospitals were doing everything possible to enact safety protocols, said Cohen.

“It’s true that patients were reluctant to come to the hospital because they were concerned that they would have the potential to get COVID in the hospital,” he said.

But they felt safer after his hospital and many others created two separate pathways, one dedicated to COVID-19 patients, the other to non-COVID-19 patients so the two did not mix, minimizing the spread of infection.

In mid-Atlantic states like New York, New Jersey and Pennsylvania, where there were high numbers of coronavirus infections, there was a 71 percent decrease in the overall case volume from 2019 to 2020, with 75 percent fewer elective cases, and a 59 percent reduction in non-elective cases.

The New England states of Maine, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island saw a 63 percent decline in heart surgeries in the same period.

Altogether, there were 65 percent fewer elective surgeries and 40 percent fewer non-elective surgeries.

All types of heart surgeries were affected, including aortic and mitral valve replacement, coronary artery bypass grafting and others.

Dr Tom C. Nguyen at the University of California-San Francisco and colleagues gathered their data from the STS Adult Cardiac Surgery Database from Jan 1, 2018, to June 30, 2020.

They also used information from the Johns Hopkins coronavirus dashboard from Feb 1, 2020, to Jan 1, 2021.

“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 statement.