What you need to know
The COVID-19 pandemic has put significant strain on health care systems, affecting not just the treatment of severe COVID-19 but also the effective treatment of other health conditions.
Researchers from the University of Virginia wanted to understand how the pandemic has affected health care costs and the risk of death (mortality) for heart surgery. They also wanted to see whether these outcomes were different depending on a patient’s socioeconomic status.
The researchers found that the pandemic increased the cost and risk of mortality for heart procedures regardless of socioeconomic status. However, a majority of the patients undergoing surgery from March 2020 to May 2022 were of a higher socioeconomic status. This brings into question whether all patients have been receiving the care they need.
What did the researchers do?
In a study with support from the National Heart, Lung, and Blood Institute (NHLBI), researchers collected the data of nearly 40,000 patients being treated for heart issues from 17 hospitals and surgical practices across Virginia. Of those, 7,269 patients had undergone heart surgery. The data were collected between July 2011 and May 2022, and patients treated before March 13, 2020 — the start of the COVID-19 pandemic — were compared with patients treated after that date.
Researchers examined the cost of heart surgery. They calculated the mortality rate from those surgeries, which was defined as death within 30 days of surgery or a failure to rescue the patient during a surgical complication. To measure the patients’ socioeconomic status, the researchers applied the Distressed Communities Index (DCI) to the ZIP codes where the patients lived. The DCI uses the following key measurements:
Percentage of population with a high school degree
Housing vacancy rate
Median income ratio
Change in employment (number of jobs)
Change in number of business establishments
Mortality rates from heart procedures increased for everyone. The increase in deaths was driven by higher failure-to-rescue rates (death after surgery from potentially treatable complications), which the researchers believe resulted from health care staff shortages and strains on resources during the pandemic. The cost of surgery also increased for every patient.
The researchers also found that some health disparities may have widened because of the pandemic. Even before the pandemic, patients of lower socioeconomic status have been found to have worse outcomes from heart surgery. But after the start of the pandemic, the researchers found that the majority of patients admitted for surgery had a lower risk for complications and were of a higher socioeconomic status. This may mean that patients with fewer resources went from having worse surgical outcomes before the pandemic to, in many cases, not receiving surgical care at all.
Why is this research important?
More research is needed to determine whether patients of a lower socioeconomic status had lower surgery rates because they could not access care or because they were opting for other non-invasive treatments. But the results of this study provide further evidence that people and communities of lower socioeconomic status have been disproportionately affected by the pandemic.
Where can I go to learn more?
NHLBI shares information on how COVID-19 affects the heart and what conditions may be affected by COVID-19.
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Kaplan, E. F., Strobel, R. J., Young, A. M., Wisniewski, A. M., Ahmad, R. M., Mehaffey, J. H., Hawkins, R. B., Yarboro, L. T., Quader, M., & Teman, N. R. (2023). Cardiac surgery outcomes during the COVID-19 pandemic worsened across all socioeconomic statuses. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2022.12.042
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