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Patients with adult congenital heart disease (ACHD) are at increased risk for poor outcomes when compared to the age matched non-ACHD population and require specialist care to optimize outcomes including well-being and survival. The COVID-19 pandemic significantly impacted healthcare provision across Canada with reduction on in person evaluations. The effect of the COVID-19 restrictions on ACHD care including clinic evaluation, diagnostic and procedures in Canada has not been well characterized.
Methods and Results
All Canadian Adult Congenital Heart Network affiliated ACHD centers were contacted and asked to collect data on outpatient clinic and procedural volumes for the 2019 and 2020 calendar years. A survey was sent to each site detailing questions on clinic and procedural volumes and wait times pre and post pandemic restrictions. Descriptive statistics were used with student t test to compare groups. Pre-pandemic (2019) there were 19326 ACHD clinic visits across Canada with 296 (1.5%) being virtual. During the first year of the pandemic (2020) there were a similar number of total clinic visits 20532, however 11412 (56%) visits were virtual p< 0.0001. Total procedural volumes for ACHD care are presented in figure 1. Pre-pandemic mean estimated clinic waiting times (in months) for non-urgent consults were: 5.4 + 2.57 vs. pandemic wait time 6.5 + 4.22, p=0.65, for elective ACHD cardiac surgery 6.0 + 3.46 vs.7.3 + 4.59, p=0.47, for ACHD electrophysiology procedures 6.3 + 3.33 vs 6.7 + 3.27 p=0.72, for ACHD percutaneous intervention 4.6 + 3.89 vs 4.4 + 2.33 p=0.74.
During the pandemic, despite social distancing restrictions, the use of virtual clinics visits have helped to maintain continuity in ACHD clinical care. The procedural volumes and wait times for consultation, percutaneous and surgical interventions were not delayed.