The indirect impact of COVID-19 on cardiac function and associated outcomes in patients awaiting cardiac surgery: An opportunity to inform data-driven surgical wait list management

During the COVID-19 pandemic, non-urgent surgeries, including many heart surgeries, were delayed to free up hospital staff and space to care for patients with COVID-19. However, waiting for heart surgery can cause permanent damage to the heart, which may impact a patient's long-term health and survival. We do not know the impact of pandemic-related delays in heart surgery on a person's heart function or longer-term health. We also do not know whether some people are especially at risk of deteriorating while waiting for heart surgery. Even before the pandemic, some groups of patients, such as women or people from poorer neighbourhoods, had long wait times for heart surgery, leading to poorer health after surgery. The pandemic may have made this trend even worse. Together, this information will be important in understanding which patients on the heart surgery waiting list should be prioritized. We will study the indirect impact of the COVID-19 pandemic on heart surgery patients at 2 hospitals in Ontario. Specifically, we will examine heart function and long-term health in 8,000 patients waiting for heart surgery in the 2 years before and the 2 years during the pandemic. Our first goal is to examine the effect of the pandemic on wait times, heart function, and long-term health in heart surgery patients. Our second goal is to identify factors (e.g., sex, income level, surgery wait time) that predict which patients will experience a decline in heart function and poor long-term health as a result of waiting for heart surgery. Because it will take many years to clear the backlog of heart surgeries caused by the COVID-19 pandemic, it is important to understand whose heart function is most likely to decline while they are on the surgery wait list. These patients should be prioritized for surgery to prevent poor long-term health. This approach could lead to better and fairer wait list policies both during and after the pandemic.