Decreased Volume of Cardiac Catheterization During the COVID-19 Pandemic and the Potential Impact on May Affect Fellows Training

A decrease in the number of cardiac catheterization procedures performed during the global coronavirus disease 2019 (COVID-19) pandemic was observed at 12 hospitals in the United States, according to a reader’s comment published in The American Journal of Cardiology.

The Cardiovascular Fellows Consortium was formed by fellows in training in the United States. The Consortium collected data on all cardiac procedures performed (cardiac catheterizations, coronary angiograms, and percutaneous coronary, endovascular, and structural interventions) between March 1 and April 15, 2020 and 2019. Data were collected by electronic query from 12 fellowship training sites in Michigan, New York, Ohio, Arkansas, Louisiana, and Colorado.

A total of 2548 procedures were performed during the COVID-19 pandemic. These rates were decreased from the 4671 procedures performed during the same period the previous year (median volume change, -47%; interquartile range [IQR], -58% to -48%). The largest decline was observed between April 1 and 15, with a median volume change of -80% (IQR, -86.2% to -72.5%). The case volume was observed to have decreased at all but 1 center.

The decline in procedure volume was consistent to observations made in Spain, where a 48% reduction in diagnostic procedures was reported. These patterns were both due to the Center for Disease Control and Prevention (CDC) recommendation for all elective procedures to be deferred in order to limit the use of resources and because the number of individuals presenting with acute coronary syndrome at hospitals has declined during the pandemic.

A side effect of the decline in cardiac catheterization laboratory volume is that the amount of hands-on training available to cardiovascular fellows in training was reduced. The COVID-19 pandemic coincided with the last quarter of the academic year in the United States when case-based learning occurs. Without a large volume of patients, trainees may have reduced technical skills or lack clinical judgement needed for successful careers in cardiac catheterization laboratories.

The Accreditation Council for Graduate Medical Education acknowledged the reduction in patient volume and the reorganization of training staff to support critical services needed during the pandemic is concerning for current fellows in training.

“[T]here is a concern amongst fellows that the time period away from the cardiac catheterization laboratory may impede their ability to hone their skill set,” concluded the article authors.

Reference

Kadavath S, Mohan J, Ashraf S, et al. Cardiac catheterization laboratory volume changes during COVID-19 – findings from a cardiovascular fellows consortium. [Published online June 11, 2020] Am J Cardiol. doi:10.1016/j.amjcard.2020.06.009