Changes in Practice/Outcomes of Pediatric/Congenital Catheterization in Response to the First Wave of COVID.

Autor:	Quinn B; Department of Cardiology, Boston Children's Hospital and Department of Pediatrics Harvard Medical School, Boston, Massachusetts, USA., Barry OM; Division of Cardiology, Morgan Stanley Children's Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA., Batlivala SP; The Heart Institute Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Boe BA; Division of Cardiology, Nationwide Children's Hospital and Department of Pediatrics Ohio State University Medical School, Columbus, Ohio, USA., Glatz AC; Division of Cardiology, Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, Missouri, USA., Gauvreau K; Department of Cardiology, Boston Children's Hospital and Department of Pediatrics Harvard Medical School, Boston, Massachusetts, USA., Goldstein BH; Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Gudausky TM; Division of Cardiology, Children's Wisconsin and Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Hainstock MR; Division of Cardiology, UVA Health, and Department of Pediatrics University of Virginia School of Medicine, Charlottesville, Virginia, USA., Holzer RJ; Division of Cardiology New York-Presbyterian Hospital and Department of Pediatrics, Weill Cornell Medical School, New York, New York, USA., Nicholson GT; Division of Cardiology Monroe Carrell Jr. Children's Hospital and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA., Trucco SM; Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA., Whiteside W; Division of Pediatric Cardiology, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA., Yeh M; Department of Cardiology, Boston Children's Hospital and Department of Pediatrics Harvard Medical School, Boston, Massachusetts, USA., Bergersen L; Department of Cardiology, Boston Children's Hospital and Department of Pediatrics Harvard Medical School, Boston, Massachusetts, USA., O'Byrne ML; Division of Cardiology and Clinical Futures, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2022 Dec; Vol. 1 (5), pp. 100143. Date of Electronic Publication: 2022 Nov 30.
DOI:	10.1016/j.jacadv.2022.100143
Abstrakt:	Background: The COVID-19 pandemic has posed tremendous stress on the health care system. Its effects on pediatric/congenital catheterization program practice and performance have not been described. Objectives: The purpose of this study was to evaluate how case volumes, risk-profile, and outcomes of pediatric/congenital catheterization procedures changed in response to the first wave of COVID-19 and after that wave. Methods: A multicenter retrospective observational study was performed using Congenital Cardiac Catheterization Project on Outcomes Registry (C3PO) data to study changes in volume, case mix, and outcomes (high-severity adverse events [HSAEs]) during the first wave of COVID (March 1, 2020, to May 31, 2020) in comparison to the period prior to (January 1, 2019, to February 28, 2020) and after (June 1, 2020, to December 31, 2020) the first wave. Multivariable analyses adjusting for case type, hemodynamic vulnerability, and age group were performed. Hospital responses to the first wave were captured with an electronic study instrument. Results: During the study period, 12,557 cases were performed at 14 C3PO hospitals (with 8% performed during the first wave of COVID and 32% in the postperiod). Center case volumes decreased from a median 32.1 cases/month (IQR: 20.7-49.0 cases/month) before COVID to 22 cases/month (IQR: 13-31 cases/month) during the first wave ( P  = 0.001). The proportion of cases with risk factors for HSAE increased during the first wave, specifically proportions of infants and neonates ( P  < 0.001) and subjects with renal insufficiency ( P  = 0.02), recent cardiac surgery ( P  < 0.001), and a higher hemodynamic vulnerability score ( P  = 0.02). The observed HSAE risk did not change significantly ( P  = 0.13). In multivariable analyses, odds of HSAE during the first wave of COVID (odds ratio: 0.75) appeared to be lower than that before COVID, but the difference was not significant ( P  = 0.09). Conclusions: Despite increased case-mix complexity, C3PO programs maintained, if not improved, their performance in terms of HSAE. Exploratory analyses of practice changes may inform future harm-reduction efforts. Competing Interests: The proposed research and manuscript were reviewed by the Congenital Cardiac Catheterization Project on Outcomes (C3PO) Research and Publications Committee, but the resulting manuscript represents the views of the authors and not that of C3PO. Dr Goldstein has received consulting fees from Medtronic, W.L. Gore & Associates, Mezzion Pharmaceuticals, and PECA Labs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2022 The Authors.)
Databáze:	MEDLINE
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