Indirect Impact of the COVID-19 Pandemic on Activity and Outcomes of Transcatheter and Surgical Treatment of Aortic Stenosis in England

  1. Glen P. Martin
  2. Nick Curzen
  3. Andrew T. Goodwin
  4. James Nolan
  5. Lognathen Balacumaraswami
  6. Peter F. Ludman
  7. Evangelos Kontopantelis
  8. Jianhua Wu
  9. Chris P. Gale
  10. Mark A. de Belder
  11. Mamas A. Mamas

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Aortic stenosis requires timely treatment with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). This study aimed to investigate the indirect impact of coronavirus disease 2019 (COVID-19) on national SAVR and TAVR activity and outcomes.

Methods:

The UK TAVR Registry and the National Adult Cardiac Surgery Audit were used to identify all TAVR and SAVR procedures in England, between January 2017 and November 2020. The number of isolated aortic valve replacement (AVR), AVR+coronary artery bypass graft surgery, AVR+other surgery, and TAVR procedures per month was calculated. Separate negative binomial regression models were fit to monthly procedural counts, with functions of time as covariates, to estimate the expected change in activity during COVID-19.

Results:

We included 15 142 TAVR cases, 13 357 isolated AVR cases, 8550 AVR+coronary artery bypass graft cases, and 6773 AVR+other cases. Before March 2020 (UK lockdown), monthly TAVR activity was rising, with a slight decrease in the SAVR activity during 2019. We observed a rapid and significant drop in TAVR and SAVR activity during the COVID-19 pandemic, especially for elective cases. Cumulatively, over the period March to November 2020, we estimated an expected 4989 (95% CI, 4020–5959) cases of aortic stenosis who have not received treatment.

Conclusions:

This study has demonstrated a significant decrease in TAVR and SAVR activity in England following the COVID-19 outbreak. This situation should be monitored closely, to ensure that monthly activity rapidly returns to expected levels. There is potential for significant backlog in the near-to-medium term and potential for increased mortality in this population.

Article activity feed

  1. Version published to 10.1161/circinterventions.120.010413
  2. ScreenIT

    SciScore for 10.1101/2020.08.05.20168922: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Several limitations should be noted when interpreting the results of this study. Firstly, we make no statistical comparisons between isolated AVR, AVR+CABG, AVR+Other or TAVR groups. Any such comparisons would be subject to confounding by indication. This means that we were not able to investigate changes in patient-level propensity to undergo SAVR vs. TAVR through the COVID-19 period, since the decision-making behind the SAVR vs. TAVR choice was not recorded in these data. Secondly, while we used the Logistic EuroSCORE to summarise overall SAVR procedural risk, this model is known to overpredict mortality risk. However, this model is commonly used for benchmarking in national cardiovascular registries, and we use the model in the same capacity here. Thirdly, this analysis is limited to procedures in England; however, given that COVID-19 has caused changes in healthcare utilisation globally, one might expect similar findings in other healthcare settings. Finally, some delays in reporting during the pandemic might contribute to some of the results; however, the British Cardiovascular Intervention Society and the Society for Cardiothoracic Surgery have made significant efforts to maintain data flows during this period, and have provided weekly uploads of data. Thus, this limitation is potentially minimised. In conclusion, this study has demonstrated a significant drop in TAVR and SAVR activity following the COVID-19 outbreak in the UK. The case-mix of patients who have undergon...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.05.20168922v1 on medRxiv