Key result
COVID-19 pandemic linked to ~2,294 untreated severe aortic stenosis cases from reduced TAVR and SAVR.
Why the study?
Aortic stenosis requires timely treatment with SAVR or TAVR, but the indirect impact of the COVID-19 pandemic on national activity and outcomes was unknown.
Did the COVID-19 pandemic reduce the procedural volume of TAVR and SAVR in patients with severe aortic stenosis?
Observational (n=39,547)
Yes
Did the COVID-19 pandemic reduce the procedural volume of TAVR and SAVR in patients with severe aortic stenosis?
Effect estimate: 2294 untreated cases (95% CI 1872-2716)
The COVID-19 pandemic led to a significant reduction in TAVR and SAVR procedures in England, creating a substantial backlog of untreated severe aortic stenosis cases.
Signals substantial backlog of untreated severe aortic stenosis cases; leaves open long-term outcome impacts and optimal recovery strategies.
Background 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 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 June 2020. The number of isolated AVR, AVR+coronary artery bypass graft (CABG) 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 13376 TAVR cases, 12328 isolated AVR cases, 7829 AVR+CABG cases, and 6014 AVR+Other cases. Prior to March 2020 (UK lockdown), monthly TAVR activity was rising, with a slight decrease in 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 June 2020, we estimated an expected 2294 (95% CI 1872, 2716) cases of severe aortic stenosis who have not received treatment. Conclusion 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.
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Martin et al. (2020) conducted an observational in Severe aortic stenosis (n=39,547). COVID-19 pandemic vs. Pre-COVID-19 period (January 2017 to February 2020) was evaluated on Presentation and treatment of severe symptomatic aortic stenosis with either SAVR or TAVR (expected change in activity) (2294 untreated cases, 95% CI 1872-2716). The COVID-19 pandemic was associated with a rapid and significant decrease in transcatheter and surgical aortic valve replacement activity in England, resulting in an estimated 2,294 untreated cases of severe aortic stenosis between March and June 2020.
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