Modelling solutions to the impact of COVID-19 on cardiovascular waiting Lists

V-KEMS Study Group, and Hoyle, Rebecca (2021) Modelling solutions to the impact of COVID-19 on cardiovascular waiting Lists 45pp.

Record type: Monograph (Project Report)

Abstract

This three-day virtual study group explored the challenges related to the delays in seeking and gaining access to cardiovascular treatments caused by the COVID-19 pandemic and the impact this will have upon waiting lists.

Background: cardiovascular disease is the leading cause of death for men in the UK and second-most for women. During the first lockdown from March 2020, elective cardiac procedures and many outpatient consultations were postponed and a substantial number of appointments have not yet been rescheduled. In addition, those who were suffering from heart conditions did not present to their GP or hospital – either because they did not want to impact further on NHS resources, or through concern of being exposed to the virus. Clinicians have been able to report what has been happening with respect to the reduction in emergency cardiac admissions and procedures, as well as quantify the excess deaths from emergency cardiac conditions. They have not quantified the impact on outpatient consultations.

It would be helpful to form a predictive model of the outcome of different strategies for recovery of the backlog in cardiac procedures and outpatient consultations, noting that a number of competing elements are at play including incident cases, prevalent cases, delayed cases, abandonment from changes in disease and deaths, as well as the capacity and capability of NHS services to respond. For example, given different strategies for recovery from this major perturbation to treatment, what would be the implications for treatment demand over timescales from say 6 months to several years? How should treatment be optimised given resource constraints? What would be the impact of additional waves of COVID-19 cases?

Aims and objectives: this study group brought together researchers and clinicians to provide further insight into these complex challenges through a variety of mathematical approaches.

Proposed issues explored related to:

1. The overarching state of the delivery of elective cardiovascular procedures and outpatient consultations at the national level, as a result of the pandemic and how this plays out at regional or local (single NHS trust) levels.
2. An exemplar procedure - Aortic Stenosis – for which there is a particularly well-defined data set and for which missed early intervention can lead to particularly adverse outcomes over the course of one or two years.
3. An exemplar condition – chronic heart failure - treatment regimens for which are less well-defined, yet the missed appointments during the pandemic represent a major perturbation to care that may impact on the optimal management of resources within cardiology departments.

These were discussed in light of the following concerns:

Where people are not presenting to clinics now, what will the impact of this be further down the line, as their health issue has not gone away? If people don’t present for treatment but don’t die, what impact does that have on resources?

What could the knock-on effect of additional lockdowns be?

If and when hospitals return to normal, what would be the optimal way to recover from the backlog and avoid a situation where more urgent cases in poorer condition are prioritised over routine earlier interventions, leading to perpetual worse outcomes for everyone.

How can we configure a decision support system that could enable day-to-day answers to these questions on the ground?

Previous work through V-KEMS discussed general mathematical principles which was considered and a number of different scenarios were modelled.

Following the event, Plus Magazine interviewed Dr Jess Enright (University of Glasgow) and Dr Ramesh Nadarajah (University of Leeds). Ramesh presented the challenges at the event and Jess was one of the modelers who helped to develop the event. The inspiring podcast can be heard here.

A working paper is published below, which highlights the discussions that took place at the Study Group and the initial findings.