Impact of COVID-19 pandemic on rates of congenital heart disease procedures among children: Prospective cohort analyses of 26,270 procedures in 17,860 children using CVD-COVID-UK consortium record linkage data

Background The COVID-19 pandemic necessitated major re-allocation of health care services. Our aim was to assess the impact on paediatric congenital heart disease procedures during different pandemic periods compared to the pre-pandemic period, to inform appropriate responses to future major health services disruptions. Methods and Results We analysed 26,270 procedures from 17,860 children between 01-Jan-2018 and 31-Mar-2022 in England, linking them to primary/secondary care data. The study period included pre-pandemic and pandemic phases, with latter including three restriction periods and corresponding relaxation periods. We compared procedure characteristics and outcomes between each pandemic periods and the pre-pandemic period. There was a reduction in all procedures across all pandemic period with the largest reductions during the first, most severe restriction period (23-Mar-2020 to 23-Jun-2020), and the relaxation period following second restrictions (03-Dec-2020 to 04-Jan-2021) coinciding with winter pressures. During the first restrictions, median procedures per week dropped by 51 compared with the pre-pandemic period(80 vs 131 per week, p = 4.98×10 -08 ). Elective procedures drove these reductions, falling from 96 to 44 per week, (p = 1.89×10 -06 ), while urgent (28 vs 27 per week, p = 0.649) and life-saving/emergency procedures (7 vs 6 per week, p = 0.198) remained unchanged. Cardiac surgery rates increased, and catheter-based procedure rates reduced during the pandemic. Procedures for children under 1-year were prioritized, especially during the first four pandemic periods. No evidence was found for 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 Prioritization of urgent, emergency and life-saving procedures during the pandemic, particularly in infants, did not impact paediatric CHD post procedure complications or mortality. This information is valuable for future major health services disruptions, though longer-term follow-up of the effects of delaying elective surgery is needed.