Po-02-028 negative effects of covid-19 on the implantation rate of cardiac resynchronization therapy with defibrillator device.

Coronavirus-19 (COVID-19) pandemic drastically changed the landscape of the US medical system. Total surgical procedure volume declined across all specialties, primarily in elective procedures. Multiple task forces promoted the cancellation of nonurgent elective procedures, including the implantation of a Cardiac Resynchronization Therapy Defibrillator (CRT-D) in stable patients during the pandemic. The effect of COVID-19 on the rate of CRT-D implantation is poorly understood. We aim to explore the impact of the COVID-19 pandemic on CRT-D insertion rates, along with negative outcomes related to delays in care. We conducted a retrospective analysis using the National Inpatient Sample (NIS) database for patient encounters involving the insertion of CRT-D between 2017 & 2020. Variables were identified using their ICD-10 codes. Admissions were included if the patient was at least 18 years of age, presenting for a non-elective admission, had a primary diagnosis of hypertensive heart disease, hypertensive heart, and chronic kidney disease, or heart failure (ICD-10 codes I11, I13, I50), and underwent insertion of a CRT-D (ICD-10 code 0JH**9*). Between 2017 and 2020, CRT-D devices were inserted during 23,635 admissions. On average, 6,198 devices were implanted yearly from 2017 to 2019, with only 5,040 being implanted in 2020. CRT-D implant rates dropped below their previous 3-year average in every region of the US during 2020 (Figure 1). Additionally, the highest average death rate at 13.89%, but this difference was statistically insignificant (adjusted Wald test p=0.767), and COVID-19 was not associated with an increased risk of inpatient mortality (OR 0.22, 95% CI 0.03-1.82, p=0.162). Blacks were disproportionately affected by a reduction in CRT-D procedures for this demographic in 2020 as compared to other races. COVID-19 pandemic has affected all facets of the healthcare system, especially surgical volume rates. Consistent with many other procedures, CRT-D procedures significantly decreased in 2020 following multiple task force recommendations to postpone nonurgent procedures in the setting of rampant COVID-19 infections. To our knowledge, this is the first retrospective study highlighting the trend of decreased rates of CRT-D implantation as a response to the COVID-19 pandemic.