Introduction: The COVID-19 pandemic has had a major impact on healthcare services, however the effect has been heterogeneous. We collated cardiac rhythm management (CRM) service provision data from two specialist cardiothoracic centres in the UK without Eds, the Liverpool Heart and Chest Hospital (LHCH) and Royal Papworth Hospital (RPH). We describe the impact of the pandemic at these two sites.
Methods: Caseload data between April 2019 and March 2021 was collected from RPH and LHCH databases. COVID-19 data was obtained from www.coronavirus.gov. The proportion of total beds occupied by COVID-19 patients was used as a surrogate for strain on hospital resources, termed ‘Covid Strain’. Student’s T tests were used to compare data.
Results: Pre-pandemic (April 2019-February 2020), despite having fewer beds than RPH (187 vs 300), monthly CRM procedure numbers were greater at LHCH: RPH 222 ± 27, LHCH 250 ± 26 (mean ± SD), p=0.02. There were differences in the proportion of different procedures, with RPH performing more accessory pathway ablations, lead revisions and ILR explants, and LHCH performing more AV node ablations, ICD, and CRT implants. During the first lockdown (March-June 2020) both centres were dramatically affected with a 97% and 98.2% drop in EP cases and a 36.7% and 56.9% drop in device procedures for RPH and LHCH respectively at their nadirs (relative to pre-pandemic averages). By contrast, during the second lockdown period (November 2020-March 2021) EP activity reduced by 79.8% at RPH but only 31.0% at LHCH, more strikingly, device activity was 58.6% reduced at RPH but showed no decline at LHCH (+3.8% compared to pre pandemic average). We hypothesised that this resilience might have been due to an altered casemix at LHCH during wave 2. However, the proportions of different procedures were unchanged and were the same as during wave 1 (when both centres had been similarly impacted). During lockdown 1 Covid Strain was similar between the two centres, peaking at 14.7% (RPH) and 9.7% (LHCH). However, during the second wave COVID-19 occupancy at LHCH reached a peak of 8.6% in December 2020 (lower than wave 1). At RPH however there was a sustained peak (reaching 18.8% – higher than wave 1) lasting until February 2021. It is likely therefore that it was the fact that RPH was working at higher capacity due to non-CRM workload that determined the differing second wave response. Panel A (upper) of Figure 1 summarises the relative monthly number of procedures (bar chart) for LHCH (left) and RPH (right), as well as waiting lists (line chart) for EP (red) and device (blue). Both centres managed to protect device services, however EP waiting times have risen during the pandemic, particularly at RPH. Panel B (lower) demonstrates the Covid Strain over the pandemic.
Conclusions: By prioritising device procedures, device waiting lists were relatively spared. EP activity was heavily impacted at both centres, with a knock-on rise in waiting lists. RPH was under greater and more sustained pressure during wave 2 due to regional ICU load-levelling manoeuvres.