Cardiovascular
COVID-19 Pandemic-Related Healthcare Disruptions and Risk of Major Adverse Cardiovascular Outcomes Among Older Adults with Multiple Chronic Conditions in New York City, 2020-2024 Lorna Thorpe* Sarah Conderino Conderino Conderino Conderino Conderino Conderino Conderino Conderino Conderino Conderino Conderino NYU Grossman School of Medicine
Background: Trends in major adverse cardiac events (MACE) have increased in the years following the COVID-19 pandemic onset. Beyond the direct impacts of COVID-19 infection, healthcare disruptions during the pandemic may have influenced long-term cardiovascular health outcomes. Our objective was to estimate the impact of care disruption on risk of MACE among older adults with multiple chronic conditions (MCC) in New York City (NYC).
Methods: Using electronic health record data from the INSIGHT Clinical Research Network, we established a retrospective cohort of NYC residents aged ≥50 years diagnosed with MCC prior to the pandemic. We monitored their healthcare encounters, diagnoses, and hospitalizations for four years, from March 7, 2020–December 31, 2024. Total care disruption during the acute pandemic was defined as having no ambulatory or telehealth visits for seven months, between March 7, 2020–October 6, 2020. We conducted a survival analysis using accelerated failure time models to assess the association between care disruption and subsequent diagnosis of MACE, defined as hospitalization for acute myocardial infarction, ischemic stroke, heart failure, cardiac arrest, or unstable angina.
Results: Among 271,303 patients in the cohort, 20.3% experienced total care disruption during the acute pandemic phase. On average, adults with disrupted care had lower pre-pandemic healthcare utilization (8.5 vs. 17.1 visits) and fewer comorbidities (3.2 vs. 3.8) than those who received care. A total of 9.4% of patients with disrupted care experienced MACE, compared to 10.2% of those without disrupted care. After adjusting for demographic and pre-pandemic clinical covariates, total care disruption was associated with shorter median time to incident MACE (Time Ratio=0.91; 95% CI: 0.88–0.95).
Conclusion: Total care disruption during the initial months of the pandemic was associated with increased risk of incident MACE in this patient population of NYC older adults with MCC.