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2020 ; 36
(8
): 1308-1312
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gab.com Text
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The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac
Resource Capacity During the COVID-19 Pandemic
#MMPMID32447059
Tam DY
; Naimark D
; Natarajan MK
; Woodward G
; Oakes G
; Rahal M
; Barrett K
; Khan YA
; Ximenes R
; Mac S
; Sander B
; Wijeysundera HC
Can J Cardiol
2020[Aug]; 36
(8
): 1308-1312
PMID32447059
show ga
In Ontario on March 16, 2020, a directive was issued to all acute care hospitals
to halt nonessential procedures in anticipation of a potential surge in COVID-19
patients. This included scheduled outpatient cardiac surgical and interventional
procedures that required the use of intensive care units, ventilators, and
skilled critical care personnel, given that these procedures would draw from the
same pool of resources required for critically ill COVID-19 patients. We adapted
the COVID-19 Resource Estimator (CORE) decision analytic model by adding a
cardiac component to determine the impact of various policy decisions on the
incremental waitlist growth and estimated waitlist mortality for 3 key groups of
cardiovascular disease patients: coronary artery disease, valvular heart disease,
and arrhythmias. We provided predictions based on COVID-19 epidemiology available
in real-time, in 3 phases. First, in the initial crisis phase, in a worst case
scenario, we showed that the potential number of waitlist related cardiac deaths
would be orders of magnitude less than those who would die of COVID-19 if
critical cardiac care resources were diverted to the care of COVID-19 patients.
Second, with better local epidemiology data, we predicted that across 5 regions
of Ontario, there may be insufficient resources to resume all elective outpatient
cardiac procedures. Finally in the recovery phase, we showed that the estimated
incremental growth in waitlist for all cardiac procedures is likely substantial.
These outputs informed timely data-driven decisions during the COVID-19 pandemic
regarding the provision of cardiovascular care.