Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales
Background Infants with congenital heart disease (CHD) are clinically vulnerable to cardiac deteriorations and intercurrent infections. We aimed to quantify the impact of health system disruptions during the COVID-19 pandemic, on their clinical outcomes and whether these differed by socioeconomic an...
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BMJ Publishing Group
2025-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e002964.full |
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| author | Massimo Caputo Christina Pagel Sonya Crowe John Nolan Deborah A Lawlor Qi Huang Rodney CG Franklin Kate L Brown Ferran Espuny-Pujol |
| author_facet | Massimo Caputo Christina Pagel Sonya Crowe John Nolan Deborah A Lawlor Qi Huang Rodney CG Franklin Kate L Brown Ferran Espuny-Pujol |
| author_sort | Massimo Caputo |
| collection | DOAJ |
| description | Background Infants with congenital heart disease (CHD) are clinically vulnerable to cardiac deteriorations and intercurrent infections. We aimed to quantify the impact of health system disruptions during the COVID-19 pandemic, on their clinical outcomes and whether these differed by socioeconomic and ethnic subgroups.Methods In this population-based cohort study, we used linked electronic healthcare datasets from England and Wales to identify infants with nine sentinel CHDs born and undergoing intervention in 2018–2022. The outcomes of cardiac intervention timing, infant mortality and hospital care utilisation, were described by birth eras, and risk factors were explored using multivariable regression.Results Of 4900 included infants, 1545 (31.5%) were born prepandemic (reference), 1175 (24.0%) in the transition period, 1375 (28.0%) during restrictions and 810 (16.5%) postrestrictions. The casemix was hypoplastic left heart syndrome (195; 3.9%), functionally univentricular heart (180; 3.7%), transposition (610; 13.5%), pulmonary atresia (290; 5.9%), atrioventricular septal defect (590; 12.1%), tetralogy of Fallot (820; 16.7%), aortic stenosis (225; 4.6%), coarctation (740; 15.1%) and ventricular septal defect (1200; 24.5%).Compared with prepandemic, there was no evidence for delay in treatment procedures in transition, restrictions or postrestrictions eras. Infant mortality increased for those born in the transition period, adjusted OR 1.60 (95% CI 1.06, 2.42) p=0.01, but not in restrictions or postrestrictions. The days spent at home were similar with birth in transition and restrictions, but fewer for postrestrictions, adjusted days difference −2 (95% CI −4, 0), p=0.05.Outcomes did not vary by pandemic birth era according to social characteristics. There was higher infant mortality in the deprived versus non-deprived binary category (adjusted OR 1.56 (95% CI 1.11, 2.18), p=0.004) and there were fewer days spent at home for the most versus least deprived neighbourhood quintile (adjusted difference −4 (95% CI −6, –2), p<0.001).Conclusions Specialist care for infants with CHD during the pandemic, in terms of pathway procedure timing and healthcare contacts, was not compromised. Increased healthcare utilisation postpandemic and heath inequality based on socioeconomic status require further evaluation. |
| format | Article |
| id | doaj-art-3ad129b667804ea98f6efd056264f686 |
| institution | DOAJ |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | Open Heart |
| spelling | doaj-art-3ad129b667804ea98f6efd056264f6862025-08-20T03:01:04ZengBMJ Publishing GroupOpen Heart2053-36242025-02-0112110.1136/openhrt-2024-002964Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and WalesMassimo Caputo0Christina Pagel1Sonya Crowe2John Nolan3Deborah A Lawlor4Qi Huang5Rodney CG Franklin6Kate L Brown7Ferran Espuny-Pujol8Cardiac Surgery, Translational Health Sciences, University of Bristol, Bristol, UKClinical Operational Research Unit, Department of Mathematics, University College London, London, UKClinical Operational Research Unit, Department of Mathematics, University College London, London, UKBritish Heart Foundation Data Science Centre, Health Data Research UK, London, UKPopulation Health Science,Bristol Medical School, University of Bristol, Bristol, UKClinical Operational Research Unit, Department of Mathematics, University College London, London, UKPaediatric Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UKCardiorespiratory, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UKDepartment of Computer Science, University of Reading, Reading, UKBackground Infants with congenital heart disease (CHD) are clinically vulnerable to cardiac deteriorations and intercurrent infections. We aimed to quantify the impact of health system disruptions during the COVID-19 pandemic, on their clinical outcomes and whether these differed by socioeconomic and ethnic subgroups.Methods In this population-based cohort study, we used linked electronic healthcare datasets from England and Wales to identify infants with nine sentinel CHDs born and undergoing intervention in 2018–2022. The outcomes of cardiac intervention timing, infant mortality and hospital care utilisation, were described by birth eras, and risk factors were explored using multivariable regression.Results Of 4900 included infants, 1545 (31.5%) were born prepandemic (reference), 1175 (24.0%) in the transition period, 1375 (28.0%) during restrictions and 810 (16.5%) postrestrictions. The casemix was hypoplastic left heart syndrome (195; 3.9%), functionally univentricular heart (180; 3.7%), transposition (610; 13.5%), pulmonary atresia (290; 5.9%), atrioventricular septal defect (590; 12.1%), tetralogy of Fallot (820; 16.7%), aortic stenosis (225; 4.6%), coarctation (740; 15.1%) and ventricular septal defect (1200; 24.5%).Compared with prepandemic, there was no evidence for delay in treatment procedures in transition, restrictions or postrestrictions eras. Infant mortality increased for those born in the transition period, adjusted OR 1.60 (95% CI 1.06, 2.42) p=0.01, but not in restrictions or postrestrictions. The days spent at home were similar with birth in transition and restrictions, but fewer for postrestrictions, adjusted days difference −2 (95% CI −4, 0), p=0.05.Outcomes did not vary by pandemic birth era according to social characteristics. There was higher infant mortality in the deprived versus non-deprived binary category (adjusted OR 1.56 (95% CI 1.11, 2.18), p=0.004) and there were fewer days spent at home for the most versus least deprived neighbourhood quintile (adjusted difference −4 (95% CI −6, –2), p<0.001).Conclusions Specialist care for infants with CHD during the pandemic, in terms of pathway procedure timing and healthcare contacts, was not compromised. Increased healthcare utilisation postpandemic and heath inequality based on socioeconomic status require further evaluation.https://openheart.bmj.com/content/12/1/e002964.full |
| spellingShingle | Massimo Caputo Christina Pagel Sonya Crowe John Nolan Deborah A Lawlor Qi Huang Rodney CG Franklin Kate L Brown Ferran Espuny-Pujol Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales Open Heart |
| title | Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales |
| title_full | Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales |
| title_fullStr | Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales |
| title_full_unstemmed | Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales |
| title_short | Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales |
| title_sort | peripandemic outcomes of infants treated for sentinel congenital heart diseases in england and wales |
| url | https://openheart.bmj.com/content/12/1/e002964.full |
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