Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study
Objective During the COVID-19 pandemic, a substantial decrease was observed in hospital admissions and in-hospital procedures for patients with acute cardiovascular diseases (CVDs). The extent to which measures to prevent COVID-19 transmission, for example, lockdowns, affected the outpatient care of...
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BMJ Publishing Group
2025-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/7/e092374.full |
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| author | Michiel L Bots Robin W M Vernooij Saskia Haitjema Mark C H de Groot Annemarijn R de Boer Anna G M Zondag Wouter W van Solinge |
| author_facet | Michiel L Bots Robin W M Vernooij Saskia Haitjema Mark C H de Groot Annemarijn R de Boer Anna G M Zondag Wouter W van Solinge |
| author_sort | Michiel L Bots |
| collection | DOAJ |
| description | Objective During the COVID-19 pandemic, a substantial decrease was observed in hospital admissions and in-hospital procedures for patients with acute cardiovascular diseases (CVDs). The extent to which measures to prevent COVID-19 transmission, for example, lockdowns, affected the outpatient care of patients at higher cardiovascular risk remains unclear. We aimed to compare outpatient department (OPD) attendance, cardiovascular risk management (CVRM) and cardiovascular health (CVH) of patients at higher cardiovascular risk referred to an OPD of a tertiary care centre between preCOVID-19, during and postCOVID-19 periods.Design, setting and participants We included all adult patients at higher cardiovascular risk referred to the cardiology, vascular medicine, diabetology, geriatrics, nephrology or multidisciplinary vascular surgery OPDs of the University Medical Centre Utrecht, the Netherlands, between March 2019 and December 2022, in a prospective cohort study.Main outcome measures We assessed trends in the number of first and follow-up appointments and in the completeness of extractable CVRM indicators from the electronic health record (EHR) as a proxy for CVRM guideline adherence. CVH was determined using the Life’s Essential 8 metric (score 0–100, the higher score, the better). We investigated whether CVH differed between COVID-19 periods compared with the reference period (ie, 2019) and stratified by OPDs, using multivariable linear regression, adjusted for age, gender, CVD history and whether the patient had a previous appointment before the reference period.Results Among 15 143 patients, we observed a 33% reduction in the weekly number of first appointments during the COVID-19 pandemic, with the largest reductions in the cardiology and nephrology OPDs, with no differences between women and men. Follow-up appointments conducted remotely, compared with before the COVID-19 pandemic, increased significantly for all OPDs. CVRM indicators were up to 11% less extractable during the first lockdown yet returned to prepandemic levels directly after the first lockdown period. The CVH score of patients visiting the nephrology, vascular medicine and geriatrics OPDs during the first lockdown was 11.23 (95% CI 2.74 to 19.72), 5.68 (95% CI 0.82 to 10.54) and 5.66 (95% CI 0.01 to 11.31) points higher, respectively, compared with the prepandemic period. In between the second and third lockdowns, the CVH score was comparable to the preCOVID reference period, yet for the cardiology OPD it was significantly higher (5.54, 95% CI 2.04 to 9.05).Conclusions During the COVID-19 pandemic, weekly numbers of first appointments to OPDs decreased, and a population with a higher CVH score (ie, better CVH) visited certain OPDs, especially during the first lockdown period. These suggest that patients with poorer CVH more often avoided or were unable to visit OPDs, which might have resulted in missed opportunities to control cardiovascular risk factors and potentially may have led to preventable disease outcomes. For future epidemics and pandemics, it seems vital to develop a strategy that includes an emphasis on seeking healthcare when needed, with specific attention to patients at higher CVD risk. |
| format | Article |
| id | doaj-art-c509bad295664f099ce2f5703f2d3021 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-c509bad295664f099ce2f5703f2d30212025-08-20T03:50:54ZengBMJ Publishing GroupBMJ Open2044-60552025-07-0115710.1136/bmjopen-2024-092374Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort studyMichiel L Bots0Robin W M Vernooij1Saskia Haitjema2Mark C H de Groot3Annemarijn R de Boer4Anna G M Zondag5Wouter W van Solinge6Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsJulius Center for Health Sciences and Primary Care, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsCentral Diagnostic Laboratory, Utrecht University, University Medical Centre Utrecht, Utrecht, The NetherlandsObjective During the COVID-19 pandemic, a substantial decrease was observed in hospital admissions and in-hospital procedures for patients with acute cardiovascular diseases (CVDs). The extent to which measures to prevent COVID-19 transmission, for example, lockdowns, affected the outpatient care of patients at higher cardiovascular risk remains unclear. We aimed to compare outpatient department (OPD) attendance, cardiovascular risk management (CVRM) and cardiovascular health (CVH) of patients at higher cardiovascular risk referred to an OPD of a tertiary care centre between preCOVID-19, during and postCOVID-19 periods.Design, setting and participants We included all adult patients at higher cardiovascular risk referred to the cardiology, vascular medicine, diabetology, geriatrics, nephrology or multidisciplinary vascular surgery OPDs of the University Medical Centre Utrecht, the Netherlands, between March 2019 and December 2022, in a prospective cohort study.Main outcome measures We assessed trends in the number of first and follow-up appointments and in the completeness of extractable CVRM indicators from the electronic health record (EHR) as a proxy for CVRM guideline adherence. CVH was determined using the Life’s Essential 8 metric (score 0–100, the higher score, the better). We investigated whether CVH differed between COVID-19 periods compared with the reference period (ie, 2019) and stratified by OPDs, using multivariable linear regression, adjusted for age, gender, CVD history and whether the patient had a previous appointment before the reference period.Results Among 15 143 patients, we observed a 33% reduction in the weekly number of first appointments during the COVID-19 pandemic, with the largest reductions in the cardiology and nephrology OPDs, with no differences between women and men. Follow-up appointments conducted remotely, compared with before the COVID-19 pandemic, increased significantly for all OPDs. CVRM indicators were up to 11% less extractable during the first lockdown yet returned to prepandemic levels directly after the first lockdown period. The CVH score of patients visiting the nephrology, vascular medicine and geriatrics OPDs during the first lockdown was 11.23 (95% CI 2.74 to 19.72), 5.68 (95% CI 0.82 to 10.54) and 5.66 (95% CI 0.01 to 11.31) points higher, respectively, compared with the prepandemic period. In between the second and third lockdowns, the CVH score was comparable to the preCOVID reference period, yet for the cardiology OPD it was significantly higher (5.54, 95% CI 2.04 to 9.05).Conclusions During the COVID-19 pandemic, weekly numbers of first appointments to OPDs decreased, and a population with a higher CVH score (ie, better CVH) visited certain OPDs, especially during the first lockdown period. These suggest that patients with poorer CVH more often avoided or were unable to visit OPDs, which might have resulted in missed opportunities to control cardiovascular risk factors and potentially may have led to preventable disease outcomes. For future epidemics and pandemics, it seems vital to develop a strategy that includes an emphasis on seeking healthcare when needed, with specific attention to patients at higher CVD risk.https://bmjopen.bmj.com/content/15/7/e092374.full |
| spellingShingle | Michiel L Bots Robin W M Vernooij Saskia Haitjema Mark C H de Groot Annemarijn R de Boer Anna G M Zondag Wouter W van Solinge Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study BMJ Open |
| title | Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study |
| title_full | Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study |
| title_fullStr | Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study |
| title_full_unstemmed | Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study |
| title_short | Comparison of outpatient attendance, cardiovascular risk management and cardiovascular health across preCOVID-19, during and postCOVID-19 periods: a prospective cohort study |
| title_sort | comparison of outpatient attendance cardiovascular risk management and cardiovascular health across precovid 19 during and postcovid 19 periods a prospective cohort study |
| url | https://bmjopen.bmj.com/content/15/7/e092374.full |
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