The COVID-19 pandemic had profound impacts on healthcare systems and patients around the world. Systems faced unprecedented challenges including resource reallocation, overwhelmed hospitals, and disruptions in routine care. Retrospective studies are now assessing the long-term cumulative effects of the pandemic and associated public health measures.

A real-world, retrospective, cross-sectional study titled “Trends in major adverse cardiac events and healthcare utilization during the COVID-19 pandemic in Alberta, Canada” published recently in the journal CJC Open explored the effects in Alberta, Canada related to atherosclerotic cardiovascular disease (ASCVD). The study was conducted by Amgen Canada and in collaboration with expert clinical advisors Dr. Todd Anderson, Dr. Paolo Raggi, Dr. Jean Grégoire, Dr. Shaun Goodman, and Medlior.

What the research showed

During the first three months of the pandemic in Alberta, Canada (March to June 2020), when Alberta implemented lockdown measures, overall healthcare resource utilization (HCRU) declined significantly. Compared to the same three-month period the year before, the study observed:

• A 23% reduction in the number of healthcare visits for ASCVD-related events i.e., hospitalizations, emergency department visits, and physician office visits.
• A decline in hospitalization and ED visit rates for major adverse cardiovascular events (MACE), with the greatest declines in coronary revascularization procedures.
• An increase in the mortality rate among patients hospitalized with primary MACE endpoints.
• 13% and 27% fewer ASCVD-related general practitioner and other healthcare provider visits, respectively. Telehealth visits accounted for 38% and 35% of general practitioner and other healthcare provider visits, respectively, during this period. (Prior to the COVID-19 pandemic, there was no specific telehealth billing code available in Alberta).
• An 83% reduction in the number of diagnostic imaging tests performed.

Public health measures shifted in the next three months of the pandemic (July to September 2020) with some lockdown measures being lifted. During this time many outcomes of interest returned to predicted levels (based on the best-fit line from three years of pre-pandemic data).

However:

• The mortality rate among patients hospitalized with primary MACE endpoints remained high. This may be due to less severe patients not presenting to the hospital, which delayed healthcare-seeking behavior, or to interruptions in routine care, which altered the severity of events presenting.
• Diagnostic imaging increased again but not to predicted levels.
• Rates of urgent revascularization procedures remained low. Of note, elective revascularization procedures did not slow down during lockdowns as an administrative decision in Alberta, which differed from other regions.

Looking forward

The study highlights the importance of understanding the impact of COVID-19 on patients with chronic conditions and emphasizes the need for improved healthcare planning and resiliency during a crisis.

Medlior has knowledge and expertise in conducting and publishing real-world evidence studies with both industry-sponsored and public sector clients and has access to numerous real-world datasets. Contact us at to find out more.

Reference

Erin S. Mackinnon, Todd Anderson, Paolo Raggi, Jean Grégoire, Rajvi J. Wani, Millicent S. Packalen, Erin Graves, Paul Ekwaru, Suzanne McMullen, Shaun G. Goodman. Trends in major adverse cardiac events and healthcare utilization during the COVID-19 pandemic in Alberta, Canada. CJC Open. 2023. https://www.cjcopen.ca/article/S2589-790X(23)00147-6/fulltext