Abstract 17083: SARS-CoV-2 Dramatically Decreases Healthcare Access for Patients With Cardiovascular Disease

Abstract

Background: In the setting of SARS-CoV-2 the public has sought to avoid any unnecessary contact, leaving their homes only when absolutely necessary. Hypothesis: We hypothesized that patients largely stopped seeking care for their acute CV conditions as they sheltered in place in the setting of Covid-19. Methods: We assessed changes in access to CV medical care at multiple levels, including Emergency Medical Services (EMS) call volumes in local Durham and Orange County (population 469,000), as well as for CV clinic appointments, inpatient CV census, ST elevation myocardial infarction (STEMI) activations and Emergency Room (ER) visits for a CV complaint at Duke University Hospital, which provides care for a catchment area of about 3.9 million residents, between the first and second half of March 2020. Results: Interactions for CV conditions dropped significantly at almost every level of entry into the healthcare system between the first and second half of March 2020 (Table, Figure). Conclusions: During the current pandemic, CV patients appear to have a significantly higher threshold to seek medical care. The older population of patients with CV disease may be particularly predisposed to remain in isolation due to the higher risk. Patients not receiving medical care may be continuing to decompensate. They may be more likely to die at home, or when they do present for care it may be at a later stage, leading to increased morbidity and mortality. Understanding and addressing the profound change in acute CV care may be almost as important as controlling the virus and its direct consequences, especially as the healthcare systems begin to evaluate how to best re-engage with their patients.