The study, led by Dr Elena Arbelo at Hospital Clínic of Barcelona, aimed to determine the impact of coronavirus on the number of pacemakers and defibrillators implanted per month, before and after a state of alarm was declared in Spain in March 2020. Data on the number of electronic cardiac devices implanted between 2017 and 2020 was collected from nine Catalan hospitals. Six of these hospitals are found in Barcelona, including Clínic, Vall d'Hebron and Sant Pau. The other three are each in one of the provincial capitals: Girona, Tarragona and Lleida. This data represents 90% of cardiac device implantation activity in Catalonia.
A mathematical model is used to estimate the number of monthly implantations, in order to be able to compare it with the months since the beginning of the pandemic. An average of 250 cardiac devices were implanted per month between 2017 and February 2020. The study showed a drastic reduction in the number of cardiac devices implanted compared to the pre-COVID era: in March 2020, it dropped to 207 per month and in April only 131 were implanted. This is a reduction of more than 56%.
According to statistical estimates, there was a total decrease of 153 implantations during the pandemic. More specifically, if we compare it to the same period in 2019, an even more pronounced decrease can be observed, with 188 fewer devices.
The causes of the reduction
With the spread of the coronavirus, governments implemented several restrictive measures such as lockdown and social distancing. They also advised against using emergency services for non-emergency conditions. These measures may be one of the reasons for the reduction observed in this study, as they may have led patients to avoid or delay medical consultations, either in primary care or in the emergency department.
On the other hand, non-urgent or critical patient visits were postponed or suspended at most hospitals, meaning that some patients who may have been considered for pacemaker implantation were not seen.
Furthermore, there was a fear of contagion amongst the population that may have left patients reluctant to go to hospital facilities.
Therefore, this study suggests the possibility of increased mortality and morbidity in people with heart disease, such as cardiac insufficiency or arrhythmia, as more than half of patients who may need this type of device have not received them.
While most studies to date have analysed the impact of the pandemic on the reduction of heart attack or stroke diagnoses in emergency departments, so far there is no data on the impact on the number of electronic cardiac devices implanted over this period. However, there have been concerns about how this activity has been affected by the health collapse caused by COVID-19.
This data highlights the importance of finding measures to compensate for this decrease in diagnosis and treatment of heart problems, and ways to avoid major impacts on the population's long-term health.
Information documented by: Dr Lluís Mont, Head of the Atrial Fibrillation Unit, Clinical Cardiovascular Institute