On March 11, 2020, the World Health Organization made the announcement that the coronavirus-2019 (COVID-19) was officially characterized as a pandemic.1 As many healthcare resources were redeployed or redistributed to address the acute need of COVID-19, large impacts on health systems were observed. To prevent further spread of the virus, individuals were instructed to postpone or opt for telemedicine options in place of their routine healthcare appointments. Even more concerning, some individuals may have delayed going to the hospital in emergency situations due to COVID-19 risks.3 Atherosclerotic cardiovascular diseases (ASCVD) are a major contributor to healthcare burden and patient morbidity/mortality, therefore, disruptions in regular appointments and management of ASCVD during the COVID-19 pandemic would be devastating.
ASCVD is an umbrella term for cardiovascular diseases including but not limited to myocardial infraction, angina, stroke/transient ischemic attack, and peripheral arterial disease.2 Laboratory tests are often used in the management of ASCVD. The most common laboratory test administered to patients with ASCVD or at high-risk for ASCVD is low-density lipoprotein cholesterol (LDL-C) levels, which are used to monitor cholesterol levels to reduce the risk of a cardiovascular event. Troponin is another common laboratory test used to understand the severity of a cardiovascular event by measuring troponin levels after the event.
As a part of a larger real-world evidence study examining COVID-19 pandemic disruptions in ASCVD outcomes across Alberta, Canada, Amgen Canada sponsored a study in collaboration with four expert clinical advisors and Medlior to presented a poster at the Canadian Congress of Cardiology, October 20-23, 2021, focusing on pandemic induced disruptions in troponin and LDL-C laboratory test volumes across Alberta.
To explore the COVID-19 pandemic induced disruptions in troponin and LDL-C test volumes, a repeated cross-sectional study design captured population-level troponin and LDL-C laboratory test volumes between March 15, 2019 to March 14, 2021. Three-month cross-sections were derived to report laboratory test volumes by different COVID-19 restriction periods during 2020-2021, using 2019-2020 as a preceding control period. See the figure below for details.
Our results found that test patterns during the COVID-19 restrictions period (March 15 to June 14, 2020) showed marked reduction in test volumes from the previous control year, particularly for LDL-C test volumes. LDL-C test volumes reduced by 63%, while troponin test volumes reduced by 18%. In the summer months (June 15 to September 14, 2020), as COVID-19 pandemic restrictions eased, testing volumes rebounded to near pre-pandemic volumes. However, in the fall and winter months, troponin test volumes were decreased again. See Figure 1 below.
To further understand of the impact that the COVID-19 pandemic on troponin and LDL-C test volumes in Alberta, our results were stratified by sex, age, and geographic location. Overall, women, despite having lower test volumes, had slightly higher declines in both troponin and LDL-C test volumes. In addition, those ≥80 years of age had the highest decreases in troponin laboratory test volumes (-25%); unlike LDL-C test volumes, where individuals ≥80 years of age had the smallest decrease in test volumes (-41%). See Table 1 for details.
This study observed decreases in ASCVD-related laboratory test volumes during the COVID-19 pandemic which may have been accompanied by other important changes in indicators of healthcare utilization and associated clinical outcomes. Ongoing analyses will further explore the impact of the COVID-19 pandemic in this patient group. Stay tuned!
View the full poster here for more information about this research.
- Khera A, Baum SJ, Gluckman TJ, et al. Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology. Am J Prev Cardiol. 2020;1:100009.
- Vassy, Jason L, et al. “Estimation of Atherosclerotic Cardiovascular Disease Risk Among Patients in the Veterans Affairs Health Care System.” JAMA Network Open, vol. 3, no. 7, 2020, p. e208236.