90. Impact of United States COVID-19 Regional Changes on Prenatal Diagnosis and Surgical Outcomes of Congenital Heart Disease: A Fetal Heart Society and Society of Thoracic Surgeons Collaborative Study

Objective: To describe regional practice changes in fetal cardiology during the 1st year of the COVID-19 pandemic and assess impact of restrictions on prenatal diagnosis, surgical outcomes and disparities for neonatal critical congenital heart disease (CCHD) in the United States.
Methods: A multi-institutional retrospective cohort study of CCHD (surgery<60 days of birth) neonatal outcomes was performed. Pandemic era regional practice changes were obtained from a prospective cross-sectional Fetal Heart Society survey including regional policies, fetal cardiology triage and referral fluctuations. Society of Thoracic Surgeons Congenital Heart Surgery Database provided data on patients. CCHD neonates born in the pre-pandemic era (2/1/19-2/2/20) were compared to those born during peak pandemic (03/13/20-11/1/20). Prenatal diagnosis, demographics, outcome data and area deprivation index (ADI) were collected. Wilcoxon rank-sum and chi-squared tests performed univariable analyses.
Results: Surveys completed by 73 fetal cardiologists nationally (9 US regions) indicated 54(75%) institutions implemented restrictions by 3/20/20 which eased by 11/1/20 for 30(72%). Forty-nine (69%) respondents agreed that pandemic restrictions led to triage changes and decreased referrals/visits. Sixty-four (89%) respondents reported clinic visit decreases ranging from 1-20% (n=15), 21-40% (n=22), 41-60% (n=21), and 61-80% (n=6). Comparing CCHD patients born during the pre-pandemic (n=4637) vs pandemic era (n=1806), there was increased prenatal vs postnatal diagnosis during the pandemic (1184(66%) vs 2915(63%); P<0.05); no differences in complications or mortality were found (Table). Increased hospital length of stay (24 (8,83) vs 26(9,91)days; (P<0.001), increased use of hybrid stage 1 for left heart hypoplasia (n=48 vs 28; P<0.05), worse patient state ADI (5.71 ±2.53 vs 5.5±2.56; P <0.02) and better hospital state ADI (4.11±2.35 vs 4.33±2.37; P<0.001) emerged (Table). Regional variations were noted, including higher LOS in specific regions (Figure).
Conclusion: Our study highlights healthcare system resilience in managing CCHD during the COVID-19 pandemic. While pandemic-driven adjustments affected fetal cardiology referrals and triage, core aspects of prenatal diagnosis and perioperative outcomes and survival remained robust. Regional differences underscore the need for sub-analyses to identify opportunities to mitigate regional disparities for future healthcare emergencies.

Bhawna Arya (1), Miza Salim Hammoud (2), Andrew Toth (2), Kaleigh Cummins (2), Mary Donofrio (3), Anita Moon-Grady (4), Shubhika Srivastava (5), Matthew Campbell (6), Lindsay Edwards (7), Lindsay Freud (8), Rupali Gandhi (9), Anita Krishnan (3), Angira Patel (10), Shabnam Peyvandi (4), Nelangi Pinto (1), Christina Ronai (11), Kristen Sexson Tejtel (6), Joyce Woo (10), Tara Karamlou (2), (1) Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, WA, (2) Cleveland Clinic, Cleveland, OH, (3) Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, (4) University of California, San Francisco, San Francisco, CA, (5) Nemours Children's Health, Wilmington, DE, (6) Texas Children's Hospital, Houston, TX, (7) Duke University School of Medicine, Durham, NC, (8) The Hospital for Sick Children, Toronto, Ontario, (9) Advocate Children's Hospital, Oak Lawn, IL, (10) Ann & Robert H. Lurie Children Hospital of Chicago and Northwestern University Feinberg School of Me, Chicago, IL, (11) Boston Children's Hospital, Boston, MA

Lindsay Freud

Commentator

Lindsay Freud, MD, FASE, FAHA is the Section Head of Fetal Cardiology at the Hospital for Sick Children and an Associate Professor of Paediatrics at the University of Toronto. 

Bhawna Arya

Abstract Presenter

Bhawna Arya, MD is an Associate Professor of Pediatrics at the University of Washington School of Medicine. She is the Director of the Prenatal Diagnosis Program in the Fetal Care and Treatment Center at Seattle Children’s Hospital and the University of Washington. She is also the Director of Fetal Cardiology in the Heart Center at Seattle Children’s Hospital and Fellowship Director for the Non-invasive Training Program. Dr. Arya is a pediatric cardiologist with advanced cardiovascular imaging training focused on fetal echocardiography and advanced modalities in transthoracic and transesophageal echocardiography. Her research interests are focused on fetal cardiac imaging, counseling, and short and long-term outcomes. She has also spent the last several years developing and expanding a robust multidisciplinary prenatal program which serves a large geographical area spanning 5 states. At a national level, she serves as a member-at large on the American Society of Echocardiography (ASE) Foundation Board, as well as Treasurer on the Executive Board of Directors for Fetal Heart Society.

Specialties: Congenital