Descriptive Analysis of Changes to Cardiovascular Healthcare Resource Use Recorded in Malaysian Real World Data from the Syntium Database before, during and after the COVID-19 Pandemic

OBJECTIVES: The COVID-19 pandemic had a substantial impact on the diagnosis and treatment of clinical conditions. We investigated changes in cardiovascular healthcare resource use (HCRU) over this period in a non-western setting.

METHODS: Study data came from the Syntium database of electronic healthcare records from a specialist Malaysian tertiary care cardiovascular and thoracic institution and included events between January 2019 and December 2022 inclusive (study period). Foreigners were excluded to avoid bias due to travel restrictions. Descriptive analyses of HCRU were repeated for each calendar quarter in the study period.

RESULTS: The study included >880,000 patient contacts. A drop in adult coronary artery procedures (Percutaneous Transluminal Coronary Angioplasty PTCA or Coronary Artery Bypass Surgery ) was seen in quarter two of 2020 and quarter one of 2021 (n=694 and 843 respectively), with an increase in between (mean 1,111), compared to a mean of 992 procedures in other quarters. The proportion which were PTCA increased over time but remained fairly consistent in the pandemic. A slight drop in those with acute ischaemic heart disease (ICD-10 code I21, I22 or I24 in the 72 hours prior to the procedure) continued into second quarter of 2021. Across all ages, there was no movement from warfarin to non-vitamin K antagonist (NOAC) anticoagulation at discharge in 2020. Outpatient attendances per patient dipped in quarter 1 2020. A parallel dip in the percentage with an echocardiogram did not return to pre-COVID-19 levels (6.6% pre-quarter 2 2020 compared to 5.8% during and after).

CONCLUSIONS: Changes in cardiac HCRU were seen in the pandemic. Levels generally returned to normal. Patients transferred from COVID-19 treating hospitals could account for the temporary increase in coronary artery procedures. The continued lower rate per outpatient of echocardiograms warrants further investigation. The use of NOACs did not increase despite requiring less healthcare contact.