Effects of COVID-19 Pandemic on a Health Care System: Case Study of the CirculatORy System in LiThuania

NCT05021575 | Completed

• 2 other identifiers: S-COV-20-272020/8-1247-730
• Study Type: observational
• Target: 839,678
• Locations: 1 country
• Sites: 3

Brief Summary

Coronavirus disease of 2019 (COVID-19) affected the health care systems all around the world. The collateral damage of the pandemic on the cardiovascular (CV) care and CV mortality has been noticed and reported early. In Lithuania, first quarantine measurements were introduced on 16th March and lifted on 16th June of 2020, limiting contact appointments to urgent care only. This led to a substantial proportion of routine cardiovascular appointments, diagnostic and therapeutic procedures being cancelled and greatly limited the availability of cardiovascular care. The prognostic impact of this has not been appropriately analysed. Also, comprehensive analyses of the changes in national CV services, including outpatient care and hospitalisations and CV mortality, during different periods of the pandemic (during first and second waves and in between) are scarce. The objectives of this population-based study were: (1) to assess the impact of the COVID-19 pandemic on CV care (2) to compare rates of outpatient care visits and hospitalisations of cardiovascular patients in different periods of 2019 and 2020 (3) to compare the rates of CV mortality in Lithuania in different periods of 2019 and 2020 (4) to investigate sex and age differences in CV care and CV mortality

Conditions

Cardiovascular Diseases

Keywords

cardiovascular diseases; COVID-19; health care system; cardiovascular mortality; hospitalizations; outpatient care; cardiovascular interventions

Outcome Measures

Primary Outcomes (3)

• Number of outpatient care visits for cardiovascular reasons in Lithuania in 2019 and 2020

  Assessing the impact of the COVID-19 pandemic on provision of CV care at the national and regional level in Lithuania

  2 years

• Number of cardiovascular hospitalisations in Lithuania in 2019 and 2020

  Assessing the impact of the COVID-19 pandemic on provision of CV care at the national and regional level in Lithuania

  2 years

• Cardiovascular mortality rates in Lithuania in 2019 and 2020

  Assessing the impact of the COVID-19 pandemic on provision of CV care at the national and regional level in Lithuania

  2 years

Secondary Outcomes (4)

• Evaluation of sex and age differences in changes of CV care provision and CV deaths during the pandemic and comparison between 2019 and 2020

  2 years

• In-hospital mortality rates in Lithuania in 2019 and 2020

  2 years

• Comparison of distribution of death places in Lithuania in 2019 and 2020

  2 years

• Comparison of all-cause mortality during the hospital stay and at 3 months of follow-up in patients presenting to a tertiary care centre with acute coronary syndrome during the first quarantine in 2020 and in a corresponding period of 2019

  3 months

Study Arms (2)

2020

Data on outpatient care, hospitalisation and cardiovascular mortality were collected for the year 2020.

Other: Data collection on outpatient care; Other: Data collection on hospitalisation; Other: Data collection on cardiovascular mortality; Other: Data collection of patients presenting to the tertiary care centre with acute coronary syndrome

2019

Data on outpatient care, hospitalisation and cardiovascular mortality were collected for the year 2019.

Other: Data collection on outpatient care; Other: Data collection on hospitalisation; Other: Data collection on cardiovascular mortality; Other: Data collection of patients presenting to the tertiary care centre with acute coronary syndrome

Interventions

Data collection on outpatient care OTHER

Outpatient data from 1 January to 30 November of the analysed year were obtained from National Health Insurance Fund under the Ministry of Health. Outpatient data related to cardiovascular diseases (CVD) were collected as described: 1. data on visits were collected using ICD-10 codes I00-I99 and other CVD related codes (e.g., certain Z, Q codes, J81.0, R57.0) 2. data were collected from CVD prevention program 3. data on interventional cardiology were collected from day care facility regardless of the diagnosis. Date of the visit, patient age, sex and municipality, service level (primary, secondary or tertiary), type of service and main diagnosis were recorded.

2019; 2020

Data collection on hospitalisation OTHER

Hospitalisation data from 1 January to 30 November of the analysed year were obtained from National Health Insurance Fund under the Ministry of Health. Data on hospitalisation were collected if any of the diagnoses (principal or secondary) were in I00-I99 range. Hospitalisation data covered hospitalisation date, patient age, sex, municipality and outcome. Data on cardiovascular procedures performed during hospitalisations included date of the procedure and ACHI (Australian Classification of Health Interventions) code.

2019; 2020

Data collection on cardiovascular mortality OTHER

Data on cardiovascular mortality were obtained from death certificates provided by Causes of Death Registry from Institute of Hygiene and covered the period from 1 January to 31 December of the analysed year. Death certificates were included in the study when cause of death was adjudicated to be in I00-I99 range. Date and place of death (hospital, home, other or unspecified), patient age and sex were recorded.

2019; 2020

Data collection of patients presenting to the tertiary care centre with acute coronary syndrome OTHER

Demographic, clinical and percutaneous coronary intervention (PCI) related data were collected from 1st March to 30th June of the analysed year. The timing of the chest pain onset, call for medical help, first medical contact (FMC), arrival to PCI centre, and PCI procedure were analysed.

2019; 2020

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients (≥18 years old) included in either National Health Insurance Fund outpatient and hospitalisation registries related to cardiovascular diseases from 1st January 2019 to 30th November 2020 or in Causes of Death Registry from Institute of Hygiene with cardiovascular diagnoses from 1st January 2019 to 31st December 2020.

You may qualify if:

• ≥18 years old adult patients
• Included in either National Health Insurance Fund outpatient and hospitalisation registries related to cardiovascular diseases from 1st January 2019 to 30th November 2020
• Included in Causes of Death Registry from Institute of Hygiene with cardiovascular diagnoses from 1st January 2019 to 31st December 2020.

You may not qualify if:

• Cases, when sex was not available were excluded from sex differences analysis.
• Death certificates where place of death was unspecified were excluded from death place analysis

Sponsors & Collaborators

• Vilnius University: lead
• Institute of Hygiene, Lithuania: collaborator
• National Health Insurance Fund under the Ministry of Health, Lithuania: collaborator
• Vilnius University Hospital Santaros Klinikos: collaborator

Study Sites (3)

Institute of Hygiene

Vilnius, Lithuania

Location

National Health Insurance Fund under the Ministry of Health, Lithuania

Vilnius, Lithuania

Location

Vilnius University

Vilnius, Lithuania

Location

Related Publications (1)

• Celutkiene J, Cerlinskaite-Bajore K, Bajoras V, Visinskiene R, Lizaitis M, Budrys P, Buivydas R, Gurevicius R, Serpytis P, Davidavicius G. Collateral effect of the COVID-19 pandemic on cardiology service provision and cardiovascular mortality in a population-based study: COVID-COR-LT. Clin Res Cardiol. 2022 Oct;111(10):1130-1146. doi: 10.1007/s00392-022-02033-y. Epub 2022 May 12.

  PMID: 35552504 DERIVED

MeSH Terms

Conditions

Cardiovascular Diseases; COVID-19

Condition Hierarchy (Ancestors)

Pneumonia, Viral; Pneumonia; Respiratory Tract Infections; Infections; Virus Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Lung Diseases; Respiratory Tract Diseases

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Researcher and Professor in Clinic of Cardiac and Vascular Diseases, Centre of Cardiology and Angiology, Vilnius University; Senior cardiologist in Unit of Stress testing, Vilnius University Hospital Santaros Klinikos

Study Record Dates

• First Submitted: August 23, 2021
• First Posted: August 25, 2021
• Study Start: June 1, 2020
• Primary Completion: December 31, 2020
• Study Completion: December 31, 2020
• Last Updated: August 31, 2021

Record last verified: 2021-08

Data Sharing

• IPD Sharing: Will not share

Locations

LI (3)